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On September 9th, 2024, three federal agencies issued final rules on substance use disorder care and mental health benefits. The Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury hope these rules clarify and strengthen protections to expand equitable access to these benefits. Chiefly, the release of the new final rules is part of the Biden-Harris administration’s effort to ensure more than 150 million people with private health coverage have greater access to mental health and substance use disorder care. Previously, the DOL’s Employee Benefits Security Administration (EBSA) announced updated benefit plan cybersecurity guidance to protect assets.
Background on the Substance Use Disorder and Mental Health Benefits Final Rules
Overall, the rules build on the departments’ commitment to achieving the full promise of a previously created rule. Specifically, that rule is the Mental Health Parity and Addiction Equity Act of 2008 (the Act). Specifically, the Act requires group health plans and health insurance issuers offering group and individual health insurance coverage that provides substance use disorder or mental health benefits to cover those benefits in parity with medical and surgical benefits. However, this coverage must occur without imposing more significant restrictions on mental health or substance use disorder benefits. Additionally, more than 15 years after the Act’s enactment, the departments’ enforcement efforts have shown that many still encounter barriers to accessing mental health and substance use disorder care under their health plan or coverage.
Overview of the New Final Rules
Specifically, the new rules add protections against more restrictive, nonquantitative treatment limitations for substance use disorder and mental health benefits. “Nonquantitative treatment limitations” are requirements that limit the scope or duration of benefits. Markedly, such limitations include:
- prior authorization requirements,
- step therapy, and
- standards for provider admission to participate in a network.
The final rules also prohibit plans from using biased or non-objective information. For example, these could be sources that might negatively impact access to substance use disorder and mental health benefits. Moreover, this negative impact usually occurs when designing and applying a nonquantitative treatment limitation.
Finally, the final rules make clear that health plans and insurers must evaluate the impact of their nonquantitative treatment limitations on access to mental health and substance use disorder benefits. Indeed, this evaluation must be compared to current medical and surgical benefits. The newly issued rules also require plans and issuers to collect and evaluate data related to the nonquantitative treatment limitations they place on mental health and substance use disorder care. Likewise, changes must occur if the data shows they provide insufficient access. For the most part, this will help pinpoint harmful limitations in individuals’ health coverage and remove barriers to access. Additionally, the rules emphasize the management of provider networks to strengthen access to mental health and substance use disorder care.
In the meantime, the federal agencies created a fact sheet that employers, health plan insurers, and plan representatives can utilize.
Employer Takeaways
In conclusion, recent studies indicate that employees are suffering from increased stress, anxiety, and depression due to divisive political issues and civil unrest. Subsequently, mental health issues can directly impact employee productivity and engagement in the workplace. To assist employers, WorkWise Compliance created the Mental Health in the Workplace eLearning Modules. This product includes:
- two interactive trainings on mental health in the workplace,
- guidance for employers to navigate legal issues, and
- training for employees to improve their mental health, productivity, and morale.
However, it is important to realize that one aspect of workplace mental health and well-being includes reasonable accommodations. In some situations, granting a reasonable accommodation to the employee could assist in their mental health struggles. Before fulfilling a request, however, employers need to know the basic steps of the reasonable accommodation process.
