LAC Applauds Finalization of Parity Act Regulations

The Legal Action Center (LAC) commends the recent release of finalized Parity Act regulations by the Departments of Labor, Health & Human Services, and Treasury, which incorporate many of the recommendations we made in comments submitted last fall to ensure private health insurers are covering substance use disorder (SUD) and mental health (MH) treatment services at the same levels as other medical/surgical care.

"We commend the Departments for their commitment to improving health coverage of addiction and mental health care for millions of Americans who rely on employer-sponsored and other commercial health plans," said Paul N. Samuels, President & Director at LAC. "With only 1 in 4 Americans in need of substance use treatment actually receiving services, these revised regulations will go far in rooting out discriminatory insurance practices that keep people from accessing and affording the care they need."

Notably, the Departments agreed with and incorporated LAC's suggestions regarding the following:

• Focus on Removing Discriminatory Practices: The new regulations include standards and requirements that health plans must meet to reduce the burden on consumers trying to access SUD and MH care.
  • The new Purpose section of the regulations will help ensure health plans are interpreting all provisions consistently with the fundamental purpose of the Parity Act.
  • Health plans must provide "meaningful coverage" of SUD and MH care, which is defined as a core treatment for that condition, such as medications and counseling for opioid use disorder.
  • Health plans can no longer rely on discriminatory sources or information when they design treatment limitations, such as historical data or biased evidence.
  • The new rules require health plans to collect and evaluate outcome data to measure compliance with non-quantitative treatment limitations (NQTLs) like prior authorization and network composition.

• Enforcement: The new rules also clarify the consequences of non-compliance, including, for example, requiring a health plan to stop using a particular NQTL if the plan does not submit a sufficient or compliant analysis.

• Elimination of Loopholes: The Departments narrowed overly broad exceptions that would have left loopholes for insurers, specifically those related to independent professional standards and fraud, thereby strengthening protections for consumers.

• Enhanced Access for Consumers: New provisions make it easier for individuals to obtain full comparative analyses from their health plans, empowering them to enforce their rights to equitable coverage.

Deborah Steinberg, Sr. Health Policy Attorney at LAC, said, "As overdose continues to devastate communities and mental health needs rise nationwide, the importance of addressing discrimination in health care coverage is essential. These updated regulations are a testament to the collective efforts we and our many partners have remained steadfast in. Our work does not stop here, though. We look forward to working with federal and state stakeholders to ensure these final regulations meet their full potential, and we will advocate for greater consistency in Medicaid and Medicare to protect all people from discriminatory insurance practices."

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Media Contact:
Arianne Keegan
Director of Communications, Legal Action Center
[email protected]
(212) 243-1313

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