IMHCA’s response to MHPAEA Rule Update

In August federal rules were proposed to update and strengthen the enforcement the Mental Health Parity and Addiction Equity Act of 2008. As stated in the introduction to the proposed rules:

“these proposed rules would amend the existing nonquantitative treatment limitations (NQTL) standard to prevent plans and issuers from using NQTLs to place greater limits on access to mental health and substance use disorder benefits as compared to medical/surgical benefits. As part of these changes, these proposed rules would require plans and issuers to collect and evaluate relevant data in a manner reasonably designed to assess the impact of NQTLs on access to mental health and substance use disorder benefits and medical/surgical benefits, and would set forth a special rule with regard to network composition. These proposed rules would also amend existing examples and add new examples on the application of the rules for NQTLs to clarify and illustrate the protections of MHPAEA. Additionally, these proposed rules would set forth the content requirements for NQTL comparative analyses and specify how plans and issuers must make these comparative analyses available to the Department of the Treasury (Treasury), the Department of Labor (DOL), and the Department of Health and Human Services (HHS) (collectively, the Departments), as well as to an applicable State authority, and participants, beneficiaries, and enrollees.”


The public comment period on the rule was open until October 2, 2023. IMHCA issued the following comment in support of the rule changes proposal:

“The Iowa Mental Health Counselors Association (IMHCA) is strongly in support of the proposed rules delineated in 88 FR 51552, which would strengthen the Mental Health Parity and Addiction Equity Act. These proposed rules would prevent insurance plans and issuers from limiting access to mental and behavioral health services compared to medical and surgical benefits.

IMHCA represents hundreds of mental health counselors across the state of Iowa. Compared to national averages, the availability of mental health care to Iowans is disproportionately low. These disparities are even more prevalent in our rural communities. IMHCA members are the front lines of the mental health crisis in Iowa, and frequently encounter disparity in insurance coverage and policies which only exacerbate this crisis. It is not uncommon to see insurance companies placing caps on provider networks, requiring excessive prior authorization for mental health services, limiting sessions for mental health counseling, or reimbursing providers at extremely low rates for mental health services. Not only are these problems attributable to barriers in obtaining care for many Iowans, they are real barriers for attracting and retaining high quality mental health professionals in our state.

This rule is imperative for mental health providers and patients and we are strongly in support of this effort.


The Iowa Mental Health Counselors Association Board, 2023-2024”


The full text of the proposed rule can be found here: