By John Drebinger III
Senior Advocate
On September 9, 2024, the Biden-Harris administration finalized a transformative rule that strengthens mental health and substance use disorder parity, continuing the national momentum toward improved access and accountability in behavioral health care. This announcement is a vital step forward in ensuring that mental health and substance use disorder (MH/SUD) care is as readily accessible and equitably covered as physical health services.
The Steinberg Institute is proud to have co-sponsored California’s landmark behavioral health parity law, SB 855 (Wiener), alongside the Kennedy Forum. This legislation set a national precedent, holding insurers accountable for ensuring equitable access to mental health and substance use care. While California continues to lead the way in parity policy, the new federal rule marks a significant step forward in expanding these protections nationwide, highlighting the growing recognition of the need for comprehensive behavioral health policies.
“California led the way with SB 855, and now it’s a new day for people across the U.S. who need behavioral health care,” said Steinberg Institute CEO Karen Larsen. “Getting rid of biased decision-making tools that lead to disparities in care is long overdue. With this change, care decisions will be based on sound medical criteria, not outdated or discriminatory criteria.”
New Federal Rules Emphasize Accountability and Access
The new final rule sets several critical guidelines that will improve MH/SUD care delivery nationwide. A primary focus is addressing biased decision-making tools that have long perpetuated disparities in care. Health plans must also provide more transparency around how limitations in care coverage align with the law, empowering patients to better understand their rights. These changes are critical for holding health plans accountable and ensuring that patient needs drive care decisions.
The new rules also emphasize accountability in provider network adequacy and out-of-network care costs. Health plans will be required to regularly assess the adequacy of their networks and how often they deny care through prior authorizations, ensuring that patients can access mental health and substance use services without unnecessary delays or barriers.
These requirements are crucial in addressing a pervasive issue in the behavioral health field: the lack of adequate networks and the high costs of going out of network. By improving network adequacy and reducing red tape, more patients will be able to receive care in a timely manner, saving lives.
Vice President Kamala Harris noted, “Today, we are building on this lifesaving and life-changing work by announcing the finalization of a historic rule that will expand mental health care across our nation so more of our loved ones, neighbors, coworkers, and classmates receive the care they deserve.”
A National Crisis: The Need for Reducing Barriers
The need for these federal reforms could not be more apparent. Nationally, less than half of all adults with mental illness receive treatment. For children, the statistics are even more alarming—nearly 70 percent of children who seek care for mental health or substance use cannot access it. Timely access to care is not just a convenience; it is often the difference between life and death. Mental health and substance use care saves lives, supports recovery, and helps people thrive in their communities.
The new rules also enhance enforcement for equitable non-quantitative treatment limitations (NQTLs), such as prior authorization requirements, utilization review, and provider reimbursement rates. Health plans must ensure that these limitations do not disproportionately restrict access to behavioral health care compared to medical/surgical care. Insurers will be required to collect and evaluate data on how these limitations affect access and make changes if the data show disparities. More patients will likely receive care without unnecessary barriers by increasing accountability.
Looking Forward: Building on Progress in California
California has been a leader in enforcing mental health parity, but the fight is not over. The Steinberg Institute remains committed to advocating for the full implementation of SB 855 and ensuring that regulators and health plans work to achieve both state and federal requirements. The new federal rule, with its clear focus on accountability, transparency, and patient-centered care, is a significant step forward for all Americans.
Read the full White House fact sheet on the new parity rule here.