The Departments of Labor, Health and Human Services and Treasury have proposed new rules intended to make a 15-year-old federal mental health parity law more enforceable, with a particular focus on provider networks, prior authorization and other restrictions that can make behavioral-health treatment harder to obtain than medical or surgical care. The agencies’ July 25 announcement would require group health plans and insurers to examine how nonquantitative treatment limitations operate in practice and correct material differences in access.

The proposal targets a persistent gap between formal insurance benefits and actual ability to receive care. A plan may cover psychotherapy or substance-use treatment on paper while using narrower networks, stricter authorization rules or different standards for continuing treatment. The agencies are seeking to convert the Mental Health Parity and Addiction Equity Act from a comparison of written benefit terms into a more measurable test of real access.

The rule focuses on restrictions that are difficult to compare

The original 2008 parity law generally requires financial requirements and treatment limitations for mental health and substance-use disorder benefits to be no more restrictive than comparable limits on medical and surgical benefits. Numerical limits such as copayments or visit caps are relatively straightforward to compare. Nonquantitative treatment limitations, or NQTLs, are more difficult because they include practices such as prior authorization, medical-necessity criteria, network admission standards and reimbursement methodologies.

The proposed regulatory framework would require plans and issuers to show that an NQTL is no more restrictive as applied to mental health and substance-use benefits, that its design and application satisfy specified parity standards, and that relevant data do not demonstrate material differences in access compared with medical and surgical care.

That data requirement is a major change in emphasis. It directs insurers and plans to look beyond written policies and evaluate outcomes such as provider-network composition and access. If the data show material differences, the plan would have to take reasonable action to address them.

Network adequacy is moving to the center of parity enforcement

The Labor Department also issued a technical release seeking comment on the specific data plans should collect for network-related NQTLs. Potential measures include in-network and out-of-network utilization, reimbursement rates, provider participation and other indicators that could reveal whether behavioral-health networks are materially less accessible.

This reflects a practical problem that patients frequently encounter: an insurance card can promise coverage while the network directory contains clinicians who are not accepting patients, do not treat the relevant condition or no longer participate in the plan. A parity rule based only on nominal coverage can miss that problem.

The agencies’ approach also builds on existing parity regulations and guidance, which already prohibit plans from applying more stringent processes or evidentiary standards to behavioral health without a comparable basis in medical and surgical benefits. The new proposal seeks to make those comparisons more explicit and evidence-driven.

Federal reviews have repeatedly found inadequate compliance analyses

The case for stronger rules is grounded in enforcement experience. The agencies’ 2023 report to Congress says none of the comparative analyses initially submitted during the reporting period were sufficient to demonstrate compliance. Labor and CMS investigators repeatedly had to request additional information, issue insufficiency letters and require corrective action.

The report describes concrete consequences of enforcement, including plans removing exclusions for opioid treatment programs, ending requirements that employees first use an assistance program before accessing mental health benefits, and correcting exclusions involving autism therapy. The agencies say corrective actions affected millions of participants across tens of thousands of plans.

Those findings help explain why the proposal puts more responsibility on plans to prepare robust analyses before regulators ask for them. Amendments enacted in the Consolidated Appropriations Act of 2021 already require plans and issuers to document comparative analyses of their NQTLs. The new rule would specify more clearly what those analyses must demonstrate.

The proposal could change plan operations, not just benefit language

For insurers and employers, compliance may require changes in contracting, provider reimbursement, utilization management and data systems. A plan that pays mental health professionals at rates that produce a substantially thinner network, for example, may face pressure to demonstrate why the resulting access is comparable to medical care.

For patients, the potential benefit is more practical: fewer denials based on behavioral-health-specific procedures, stronger networks and a clearer path for regulators to identify parity violations. But the proposal is not yet final. The departments are requesting public comments and may revise the framework before issuing binding requirements.

The underlying policy question is whether health coverage can be considered equal when patients encounter systematically different obstacles using it. The proposed rule answers that question more aggressively than prior regulations by treating access data as evidence of whether parity exists in practice. If finalized in similar form, the rule would move federal enforcement closer to measuring what patients actually experience rather than what their insurance documents merely promise.