History
1996: The mental health parity act stated that for all group health plans, annual and lifetime dollar limits for mental health treatment had to be the same as that for medical or surgical treatment. This did not include substance use disorder treatment.
2008: The mental health parity and addictions equity act stated that for any group health plan that offered mental health benefits, co-pays, deductibles and non-quantitative treatment limits for mental health treatment could not be more restrictive than that for medical or surgical treatment. This also included substance use disorder treatments.
2023: Updates were made to the MHPAEA, that stated that plans were required to examine the outcomes of their mental health coverage policies including out of network coverage, prior authorization and network size. Specifically, the update stated that plans could not have smaller network sizes or more stringent prior authorization requirements for mental health and substance use treatments. Non-federal government health plans (this includes plans for public employees offered through private carriers) were also required to comply with the MHPAEA.
Jan 2025: The Employees Retirement and Income Security Act (ERISA) industry committee (Also called the ERIC, it represents the interest of large employer groups) sued the US Department of Health and Human Services saying that the updates were an overreach of the authority of HHS and Department of Labor and treasury. The Blue Cross Blue Shield Association said that the updates would lead to an increase in non-indicated clinical care and reduce the quality of care being offered.
May 2025: The Department of Health and Human Services decided to reconsider the rules and publicly issued a broad non-enforcement policy, to give itself time to review the rules.
Implications
For patients: Health insurance plans that apply prior authorization requirements differentially to mental health/substance use treatments as compared to medical/surgical treatments, can continue doing so. Health insurance plans will also not be required to review and expand their mental health networks. In short, any hope of finding an in-network mental health professional easily and not having prior authorization requirements is quashed for now.
For psychiatrists who accept insurance in their practices: In the day-to-day workflow, this could mean a higher number of prior authorization requirements and poorer out of network coverage for patients, limiting the psychiatrists ability to see out of network patients.
For population health: There could be more integration of mental health into primary care, leading to more antidepressant prescriptions. Emergency rooms and primary care physicians would end up seeing a large number of patients with psychological/psychiatric complaints
Takeaway
MHPAEA has made gradual progress, but the recent legal and regulatory pause means practical parity isn’t reinforced and there are gaps mental health / substance use access and coverage.