New federal rules could soon bring big changes to health insurance coverage for individuals with autism and other developmental disabilities.

The U.S. Departments of Labor, Health and Human Services and Treasury said this month that they are issuing final rules clarifying implementation of the Mental Health Parity and Addiction Equity Act.

The 2008 law requires many insurance plans that cover mental health or substance use disorder to offer benefits for those services that are comparable to what’s provided for medical or surgical services. Despite the promise of the law, however, federal enforcement efforts show that accessing mental health care often remains more challenging than other health services, prompting the updated rules, the Biden administration said.

“Health care, whether for physical or behavioral conditions, is health care. No one should receive lesser care for one or the other. That’s the law. The rules we issue today make that clear,” said Health and Human Services Secretary Xavier Becerra.

Under the new rules, federal officials are clarifying that autism, intellectual and neurodevelopmental disorders and all other conditions listed in the mental, behavioral and neurodevelopmental disorders chapter of the current International Classification of Diseases or the Diagnostic and Statistical Manual of Mental Disorders must be included under the definition of “mental health benefits” for plans and coverage.

“This is an important designation because it targets contradictory guidelines from certain states or other authorities that have been used to deny parity protections to those with autism,” said Alexandra Smith​​​​, director of grassroots and advocacy communications at Autism Speaks. “For example, under Texas Medicaid, autism is categorized as a medical/physical condition, meaning enrollees with autism do not currently have the rights afforded by MHPAEA.”

Parity protections are important, Smith said, because they prohibit plans that cover mental health care from discriminatory practices such as excluding or limiting coverage of applied behavior analysis or habilitative services like speech, occupational or physical therapy. In addition, the law requires that insurers have adequate provider networks, so if developmental pediatricians or other needed specialists are not made available in-network to treat those with mental health conditions, there are steps patients can take to have out-of-network providers covered as in-network.

The regulatory changes mandate that health plans collect data to identify and correct any discrepancies between access to mental health care and other medical services. In addition, the rules bar insurers from using discriminatory information to dissuade access to mental health services and there are requirements intended to ensure adequate provider networks are in place, among other updates.

The new rules will also expand the reach of the law’s requirements to over 200 non-federal governmental health plans including those covering state and local government employees. In all, the White House said that the “historic” final rule will affect coverage for 175 million Americans.

The mental health parity law applies to group health plans and health insurance issuers offering group and individual health insurance coverage including mental health or substance use disorder benefits.

Provisions of the new rules will take effect in 2025 and 2026, depending on the type of plan and when it renews.

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