White House announces new mental health regulations, and Happy Birthday, 988

1.    White House announces new mental health regulations

The Mental Health Parity and Addiction Equity Act (MHPAEA) was passed 15 years ago, but most who have sought mental health or substance use care for themselves or their family members recognize that we have a long way to go. Most of those with mental health issues never obtain care, and those with substance use disorder are even more likely not to obtain care. Parents of children who need psychiatric care have an especially hard time, and severely ill children and adolescents sometimes spend days or even weeks in hospital emergency departments awaiting an inpatient psychiatric bed. Many therapists are out of network, and out of pocket costs can make mental health care unattainable.

The Biden Administration announced a new set of draft regulations this week aiming to increase access to mental health and substance use care. They require employer sponsored health plans to demonstrate that requirements for coverage are no more stringent for mental health and substance abuse treatment than for medical surgical benefits.  Further, employers will need to demonstrate parity in utilization of mental health/substance abuse treatment compared to medical/surgical treatment. Out of network payments will have to be calculated similarly for medical and mental health providers.

ABA therapy coverage will be required for any plan that covers autism spectrum disorder and eating disorder treatment must be covered for any plan that covers nutritional counseling for medical diagnoses. Employer plans will continue to be required to demonstrate that mental health and addiction services are not subjected to discriminatory levels of prior authorization, and that mental health and addiction networks are adequate. Congress added state and local governmental plans to MHPAEA in 2020, and these draft regulations would codify these changes. These regulations, once finalized, will go into effect no earlier than January 1, 2025.

The federal government also issued its annual report on MHPAEA enforcement actions this week, showing that dozens of plans were found to have violated parity rules, including non-allowed policy limits, differential cost sharing, and differential utilization management programs.

Implications for employers:

-        Requirements to comply with MHPAEA are the responsibility of the plan sponsor, and not the insurance carrier.

-        Employers should have an outside party complete a comparative analysis to be sure that they comply with MHPAEA, and these reviews increasingly should include a review of utilization data to evaluate parity.

-        Mental health access can improve dramatically with virtual care, and there are now virtual and home substance use disorder care offerings, too. 

-        Many companies have expanded their Employee Assistance Plan (EAP) offerings to supplement in-network care and provide support for the neurodiverse community. These services are not considered in Department of Labor parity evaluations.

2.    Happy Birthday, 988

Illustration by Dall-E

It’s the first anniversary of 988, the new 3 digit number for people who are feeling suicidal. In the last year, 988 has fielded over 5 million queries; over 650,000 of these were text messages. 988 has trained counselors at over 200 sites across the country, and has specific units that focus on veterans, Spanish language, and LGBTQ+. The crisis counseling in 988 is performed by a network of local and state crisis centers, which received financial and technical aid from the federal government to develop infrastructure to support 988. This hotline still has its challenges. It does not have geolocation and lacks a dedicated funding mechanism.

Implications for employers:

-        Supervisors and managers can be educated to identify mental health risks, and can refer colleagues to hotlines, employee assistance plans (EAPs), and other resources.

-        988 offers a Fact Sheet and  Social Media Shareables

Monday: Virtual prenatal care worked during the pandemic.

Hope you have a great weekeend

Jeff