New Parity Rule Strengthens Access to Mental Health Care
The Impact on Health Plans and Digital Innovation
New rules announced by the Biden-Harris administration give more teeth to the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA), which requires health plans to cover mental health and substance use benefits at the same level as physical health benefits. With the new rules, the administration is attempting to push health insurers into compliance with the law, effectively increasing access to mental health and addiction care and lowering out-of-pocket costs for consumers.
The MHPAEA was enacted to address the critical lack of mental health and addiction care for millions of Americans. Stricter rules were deemed necessary after statistics released in 2020 revealed that less than half of all adults with mental illness received treatment, and 70% of children who seek care for mental health or substance use can’t get it. Unfortunately, even with the law in force, care for these conditions continued to be significantly more difficult to obtain than physical health care. In addition, the process to get approval for care was restrictive and provider networks were too small, often forcing consumers with health insurance to see out-of-network providers and pay higher rates.
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The new rules, which go into effect January 1, 2025, mandate:
- Healthcare plans must evaluate their provider networks, out-of-network provider payments, and how often they require and deny prior authorizations to determine if a disparity exists between restrictions for mental health or substance abuse care in comparison to physical health care. If the evaluations show that they are out of compliance with the law, they will need to make changes, such as adding more behavioral healthcare in-network providers and reducing the red tape required before care can be administered.
- Healthcare plans cannot make mental health and substance use disorder (SUD) care more difficult to access than physical health benefits with more restrictive authorizations, higher costs for out-of-network providers, or offering smaller networks of providers.
- There will no longer be an exception that exempts non-federal governmental health plans, like state and local plans, from the MHPAEA.
New rules will impact health plans, healthcare providers
These new rules are poised to have a significant impact on health insurers and providers of mental health and SUD services. Above all, it’s likely that demand for mental health and SUD services will increase as barriers to access and costs drop.
An increase in clients paired with the requirement that health plans provide mental health and addiction benefits at parity with physical health care means health insurers will need to add more providers to their networks and increase their service offerings. Hiring more qualified staff quickly will not be easy in a market that’s already understaffed and stressed.
In addition, the new rules mandate that health plans conduct comparative analyses to ensure parity in reimbursement rates. This is likely to lead to adjustments in how providers are compensated by health plans, with an expected shift toward higher rates for mental health and substance use care to match physical health care. Higher reimbursement rates may help draw more professionals into the field, although that will take time, and could assist existing providers in expanding their services.
Along with these changes, healthcare providers must prepare for increased scrutiny of their compliance with the new rules. Plans will need to evaluate how often they require and deny prior authorizations, as well as the accessibility of their networks. Investments in new technologies or additional staff may be needed to manage the additional compliance data.
Harnessing digital innovations to comply with new regulation
In light of these new rules, many health insurers and healthcare providers will have to find ways to increase access and services while also collecting the required data to meet the compliance rules cost-effectively. Fortunately, digital technologies can play a critical role in helping address the challenges and opportunities presented by the new rules in multiple ways.
Digital tools can help:
Expand care access and reach without adding staff. CHESS Health’s eRecovery solution offers a customizable suite of digital health tools, all delivered via a smartphone app, allowing providers to grow their reach and offer new services to clients. Individuals in recovery from SUD are supported by the Connections app, an evidence-based app that fills critical gaps in care through 24/7 access to a certified peer-engagement team, a moderated community, and resources that reinforce coping strategies and improve treatment adherence.
The Companion app, another component of eRecovery, supports family members and caregivers of individuals with behavioral health challenges, including SUD. It provides a safe community where they can find guidance, share experiences, and access supportive resources.
These innovative tools not only transcend traditional barriers to recovery but also provide essential 24/7 crisis support, transforming the way care is delivered. By extending services beyond the confines of already-strapped providers, they empower individuals on their recovery journey and their families, ensuring that help is always within reach. As the new MHPAEA ruling mandates equal access to mental health and substance use disorder care, implementing CHESS Health’s eRecovery solution positions your organization to meet these compliance standards while enhancing the overall quality of care provided to your members and patients.
Automate screening and assessment of the need for care. CHESS Health’s ePrevention is a customizable digital platform that automates Screening, Brief Intervention, and Referral to Treatment (SBIRT), a standard public health approach to assess the need for intervention with substance use. Individuals can use this digital tool on their own, which can eliminate the need for a screening appointment, getting the person into the treatment pipeline more quickly. ePrevention delivers “smart” interventions to identify at-risk individuals and facilitates referrals to treatment or community resources.
Facilitate and track the care journey. eIntervention, another CHESS Health solution, enhances care coordination through a closed-loop referral system to efficiently connect individuals to essential services for SUDs, mental health, and social determinants of health. Digital pre-treatment resources keep patients engaged and supported in the earliest stages. Analytics provide valuable data on referrals, client numbers, locations of treatment, engagement and final outcomes that can be used for MHPAEA compliance.
Offer new services to support clients in recovery. Rewards, CHESS Health’s digital contingency management program, is part of the eRecovery solution. Rewards promote positive behavior reinforcement with a customizable digital rewards tool that seamlessly automates the delivery of contingency management. No additional staff is needed to administer the program.
Digital tools are a cost-effective, efficient way to maintain compliance
In the coming months, healthcare plans and providers will be challenged to scale their services and improve their data collection practices to stay in compliance with the new rules. Adopting digital health tools will help plans and providers remain competitive and offer better care as demand for mental health and SUD care increases.
In addition, digital technologies assist in streamlining administrative processes, such as management of new offerings like digital SBIRT and contingency management programs, and data collection by reducing the need for manual oversight.
Improving access to mental health and substance use disorder care for millions of Americans who need it is the goal of the MHPAEA and the new rules. Digital technologies offer a smart, cost-effective, and efficient path for providers to meet this moment with better care for all.
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