Attorney General James Leads Coalition of 18 Attorneys General in Calling for Mental Health and Substance Use Disorder Coverage Parity

NEW YORK – New York Attorney General Letitia James today led a coalition of 18 attorneys general in filing a comment letter urging stronger federal regulations to ensure behavioral health services are covered equally to other types of health care. The Biden Administration has proposed amendments to regulations implementing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) that would improve compliance with the law and access to mental health and substance use disorder treatment. The comment letter filed by Attorney General James and the coalition supports these efforts and offers recommendations to ensure better health care coverage to millions of Americans impacted by mental health and/or substance use disorders. 

“For too long, Americans struggling with mental health and substance use disorders have faced additional burdens when trying to access affordable care through their health plans,” said Attorney General James. “Health care plans should cover all necessary treatment, and that includes mental health and substance use disorders. I am proud to join my fellow attorneys general in supporting the Biden Administration’s Proposed Rule to strengthen mental health parity requirements and look forward to using this important tool to hold health plans accountable.” 

Since its passage in 2008, MHPAEA has required health plans to cover mental health and substance use disorder treatment the same as medical/surgical treatment, but federal and state audits have shown widespread non-compliance. Under the proposed regulations, health insurers would be required to conduct and disclose to regulators comparative, data-driven analyses of issues impacting access to treatment. These include provider network admission standards, methods for determining reimbursement rates, and procedures for ensuring network adequacy. Additionally, insurers would be required to address and resolve disparities between mental health and substance use disorder and physical health coverage.  

In their letter, Attorney General James and the coalition of attorneys general argue that collecting this data is well within the ability of health insurers and would help identify gaps and compliance red flags. The attorneys general note that health insurers routinely collect data on metrics relevant to MHPAEA compliance as part of their normal business operations, including in- and out-of-network utilization rates, claim submission rates, claim denial rates, reimbursement rates, time and distance standards, and whether providers are accepting new patients. Despite this data collection, numerous independent, peer-reviewed studies have shown that health insurers’ networks of mental health providers are in fact so-called ‘ghost networks’ due to rampant inaccuracies in provider directories. 

Additionally, the letter drafted by Attorney General James and the coalition provides recommendations for strengthening the proposed rule, and urges the federal government to omit or narrow two brand new exceptions that are overly broad and could be used by insurers to avoid providing coverage. Finally, Attorney General James and the coalition urge the relevant government agencies to quickly make the proposed rule effective, given the high level of unmet need for mental health and substance use disorder treatment and health insurers’ repeated compliance failures. The coalition concludes that by removing barriers to access, the regulations would better address America’s mental health and addiction crises. 

Joining Attorney General James in filing today’s letter are the attorneys general of California, Colorado, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, Oregon, Pennsylvania, Rhode Island, Vermont, Washington, and the District of Columbia. 

Attorney General James has been a leader on efforts to improve access to mental health and substance use disorder treatment. Attorney General James held public hearings on access to mental health care in June 2022 and January 2023 in which dozens of impacted family members, health care providers, advocates, and elected officials testified about challenges to accessing quality and affordable care in New York. In August 2021, Attorney General James announced a landmark agreement with United Healthcare to resolve allegations that United unlawfully denied health care coverage for mental health and substance use disorder treatment for thousands of Americans, securing $14.3 million in restitution for consumers. In March 2019, Attorney General James filed a historic lawsuit to hold various opioid manufacturers and distributors responsible for their roles in the opioid epidemic. Through litigation, including a jury trial victory, Attorney General James has recovered more than $2.6 billion to support New York opioid abatement, treatment, and prevention efforts from numerous companies, including Teva Pharmaceuticals, Mallinckrodt, Allergan, Endo, McKesson, Cardinal Health, Amerisource Bergen, CVS, Walgreens, and Walmart. 

This matter was handled for New York by Assistant Attorney General Michael Reisman of the Health Care Bureau. The Health Care Bureau is a part of the Division for Social Justice, which is led by Chief Deputy Attorney General Meghan Faux. The Division for Social Justice is overseen by First Deputy Attorney General Jennifer Levy.