You may have seen that the Biden-Harris administration has announced a new rule enhancing enforcement of the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA), co-authored by our co-founder, former Congressman Patrick J. Kennedy. That groundbreaking legislation sought to ensure that mental health and substance use disorders (MH/SUDs) were equitably covered by health insurance. The law experienced major gaps in enforcement, and in 2013 our organization was founded in part to ensure that Americans could get quality care without being denied coverage.

With the new rule’s release, there is a significant opportunity to see the promise of MHPAEA realized. Our policy leads discuss what happens now, what comes next, and how to move forward in the Q&A below.

Q: What is going to change?

“The major impact of the new Parity rule is that health insurance companies will be required to more meaningfully assess their Parity compliance and report it to regulators and impacted consumers,” said Chief Policy Officer Nathaniel Counts. “This includes assessing real data on access to care and taking steps to correct places where the data shows that treatment limitations are unfairly reducing access.”

When insurers provide quantifiable data in their reporting, it will more clearly show where disparities exist in several areas including:

• How much consumers pay for mental health/substance use disorder care vs. physical or surgical care
• The rate at which behavioral health providers are reimbursed — which can be much lower than other professionals in health care
• How often prescribed treatments or medications are denied due to prior authorization or other utilization management techniques
• The time and distance that consumers would need to travel to get to a provider that can treat them

The rule also plays a role for employers, providing guidance and support for self-insured employers in creating shared accountability with their third-party administrators (TPAs) to ensure their health insurance plans comply with MHPAEA.

Q: How will the new Parity rule move forward?

Parts of the new Parity rule will go into effect on January 1, 2025, while other parts will go into effect January 1, 2026. For these rules to have a meaningful impact, federal regulators need resources for implementation. This includes additional bandwidth, like having enough trained staff to oversee parity analyses.

Unfortunately, the Department of Labor, one of the key implementation agencies, is facing a funding cliff. TKF and other advocates are currently working to make sure that agencies get the funding they need to carry out the new rule.

Q: What can advocates do to support the new rule?

The new Parity rule presents a broad opportunity to help consumers learn more about their rights — and understand what to do if they’re denied mental health insurance coverage.

>>>Read Here: Everything Consumers Should Know About Being Denied Treatment

Senior Director of Policy Lauren Finke is focused on removing barriers for implementation of the new regulations, especially for state regulators, who now have clearer guidance on what they can and cannot do to enforce parity.

“State regulators have very hard jobs and ongoing capacity issues, but they have more authority and more latitude than federal regulators in some instances,” Lauren said. “For instance, they can write descriptions for what coverage plan documents should look like, or how insurers report on things.”

Lauren and the TKF policy team are devising a tool specifically created for state regulators that can alleviate bandwidth issues while empowering them in rulemaking. (Anyone can sign up to receive the guide as new priorities or focus areas are released.)

“We’re developing an easy-to-reference checklist that offers a clear guide about what to focus on in the near- and long-term,” Lauren said. “It provides a gold standard for equity that helps make the lift lighter for regulators.”

The policy team will also host a monthly Parity Working Group, which will include representatives from different industries who can keep momentum on Parity enforcement, addressing issues as they arise. Anyone who is interested in joining is encouraged to email info@thekennedyforum.org.

Q: What will happen with Parity with a new administration?

The course on parity is unlikely to shift dramatically after the 2024 election, one way or the other.

“If there are significant changes to government agencies in staffing in 2025, it could affect parity enforcement,” Nathaniel said. “But this is an issue with bipartisan support and buy-in.”

“Parity is not as high-profile or potentially divisive among Republicans and Democrats as, say, the Affordable Care Act is,” Lauren added. “Because Parity is a complex and somewhat niche policy topic, it isn’t often an area of focus for lawmakers, for better or worse.”

Ultimately, consumers or providers are unlikely to see health insurance equity go backward if there is a new administration; it is more likely that progress would simply be more difficult.

Q: Will the Chevron decision affect mental health parity?

The Supreme Court’s recent ruling overturning what is casually known as Chevron diminishes the regulatory authority of federal agencies, including health care. Some experts envision a surge in lawsuits in any matter where federal regulations come into play, though Nathaniel and Lauren believe that Parity would likely not be a focus for lawsuits. The final rule was very careful to mirror the language of the statutes, so the agencies did not rely on the kind of discretion that Chevron would have allowed.

Still, it is a moment of recalibration for agencies.

“I think agencies are uneasy because of the Chevron decision,” Lauren said. “They are really risk averse. Chevron may make agencies or lawmakers reluctant to spend time on things that could be turned over or challenged in court. I think it could be an issue in the short-term as everyone learns the implications, but probably not long-term for Parity enforcement.”

You can read a more detailed analysis of the federal Parity rule here. If you would like to see key updates about Parity or mental health/substance use disorder care, including the state guide in development by the Kennedy Forum, sign up for our email newsletter, or follow us on LinkedIn.