As part of the Biden-Harris administration’s effort to ensure more than 150 million people with private health coverage have greater access to mental health and substance use disorder care, the departments of Labor, Health and Human Services and the Treasury took significant action today by issuing final rules to clarify and strengthen protections to expand equitable access to these benefits as compared to medical and surgical benefits and reduce barriers to accessing these services. 

“Like medical care, mental health care is vital to the well-being of America’s workers,” said Acting Secretary of Labor Julie Su. “The final rules issued today make it easier for people living with mental health conditions and substance use disorders to get the life-saving care they often need.”

The rules build on the departments’ commitment to achieving the full promise of the Mental Health Parity and Addiction Equity Act of 2008. The act requires group health plans and health insurance issuers offering group and individual health insurance coverage that offer mental health or substance use disorder benefits to cover those benefits in parity with medical and surgical benefits, without imposing greater restrictions on mental health or substance use disorder benefits as compared to medical and surgical benefits. More than 15 years after the law’s enactment, the departments’ enforcement efforts have shown that many still encounter barriers to accessing mental health and substance use disorder care as compared to medical and surgical care under their health plan or coverage. 

“The final rules are critical steps forward to making sure that people in need of services can get the care they need without jumping through hoops that they don’t face when trying to get medical or surgical care,” said Assistant Secretary for Employee Benefits Security, Lisa M. Gomez. “Ending the stigma around mental health conditions and substance use disorders calls for a unified effort, and we appreciate the valuable feedback we received from stakeholders – plans, care providers and participants – in shaping these final rules.”

The new rules add additional protections against more restrictive, nonquantitative treatment limitations for mental health and substance use disorder benefits as compared to medical or surgical benefits. Nonquantitative treatment limitations are requirements that limit the scope or duration of benefits, such as prior authorization requirements, step therapy and standards for provider admission to participate in a network. 

“Simply put, getting care for anxiety should be as easy as getting medical help for an injured shoulder, and getting medication to treat depression should be as simple as getting medication to treat high cholesterol,” said Gomez. 

The final rules also prohibit plans from using biased or non-objective information and sources that might negatively impact access to mental health and substance use disorder care when designing and applying a nonquantitative treatment limitation.

“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 HHS Secretary Xavier Becerra.

The final rules make clear that health plans and insurers must evaluate the impact of their nonquantitative treatment limitations on access to mental health and substance use disorder benefits as compared to medical/surgical benefits and provide additional clarity regarding documentation requirements added to MHPAEA by the Consolidated Appropriations Act of 2021. The newly issued rules also require plans and issuers to collect and evaluate data related to the nonquantitative treatment limitations they place on mental health and substance use disorder care and make changes if the data shows they are providing insufficient access. This change will help pinpoint harmful limitations in individuals’ health coverage and remove barriers to access. In addition, the rules give special emphasis to the careful design and management of provider networks to strengthen access to mental health and substance use disorder care.

Strengthening mental health and substance use disorder parity protections has been a priority of the Biden-Harris administration and the departments, and it is a critical component of President Biden’s Unity Agenda. The final rules support the aim of improving health equity so that Americans get the care they need and deserve. 

Most provisions of the final rules apply generally to group health plans and health insurance issuers that offer group health insurance coverage starting on the first day of the first plan year beginning on or after Jan. 1, 2025, but certain requirements that may take more time to implement apply on the first day of the first plan year beginning on or after Jan. 1, 2026. The new rules also apply to grandfathered and non-grandfathered individual health insurance coverage for policy years beginning on or after Jan. 1, 2026. 

On Sept. 19, 2024, the Department of Labor will hold a compliance assistance webinar and join Treasury and HHS in providing future guidance on the rules.

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The world’s advice for U.S. voters—and the next White House.

I have a confession to make. I feel a sense of paralysis in these weeks leading up to the U.S. presidential election. Whether it’s the fate of Ukraine, peace in the Middle East, competition with China, or the broader question of America’s role in the world, too much is riding on who will be the next occupant of the White House. A Donald Trump presidency would be very different from a Kamala Harris one, and polls continue to show Americans are bitterly divided on how to choose between them. Key players in global crises, from Russian President Vladimir Putin to Israeli Prime Minister Benjamin Netanyahu, seem as if they are waiting to see who wins before they make their next big move. Perhaps that’s why it’s so difficult to cast beyond Nov. 5 and imagine how a range of conflicts and issues may play out.

Four years ago, our Fall 2020 print issue tried to examine what we called “The Most Important Election. Ever.” Little did we know we’d find ourselves at a similar crossroads in 2024. Yes, Harris has replaced U.S. President Joe Biden at the top of the Democratic ticket, but many of the issues at stake—for the United States and the world—remain the same. Columnist Michael Hirsh wrote a cover essay for us about 2020; we asked him this time around to contrast the visions presented by Harris and Trump.

But back to that paralysis: What happens after Nov. 5? For starters, there’s little guarantee the U.S. public will respect the results of the election. Even if you imagine a point in the future where Americans agree on who will lead them for the next four years, the question is how the next president should unite a polarized electorate and what issues they should prioritize.

That’s a dilemma we wanted to address in our cover package, “Dear America.” Nine distinguished thinkers with lifetimes of experience in global policymaking have written nonpartisan letters of advice to the next White House—and to Americans. With the United States no longer the world’s sole hegemon, each of them considers how Washington should approach the critical challenges our planet faces.

The political scientist Joseph S. Nye Jr., who popularized the term “soft power” in this magazine more than three decades ago, explores how the next president can restore U.S. standing in the world. “Political values attract only if a country lives up to them,” he writes. “Preaching democracy abroad will be judged by how well it is practiced at home.” Arancha González, a former Spanish foreign minister, builds on that with a call for “investing in a shield that would protect and preserve democracy for future generations.” Such a task, she argues, will require strengthening election systems, regulating social media, and bolstering cybersecurity.

The Nobel-winning economist Joseph E. Stiglitz makes the case for following the rules. “[W]e have an international trade order that enforces rules against the poor and weak … but in which the United States can do as it will,” he writes, referring to how Washington has strong-armed the World Trade Organization to serve U.S. interests. Mark Malloch-Brown, a former U.N. deputy secretary-general now based in London, argues that “what’s good for the United States is more than ever not always good for the rest of the world. … There is a dangerous divergence.” The solution, Malloch-Brown says, is for Washington to reverse its current multilateral posture and become more of a team player. It’s a sentiment echoed thousands of miles away in Singapore, from where the scholar Danny Quah calls the United States out for its “obsession with being No. 1” at the cost of global stability. “We want America in our world—just as we want China in it, too,” Quah says.

Our letter writers don’t always agree with each other. But we felt they all had one thing in common from their many years in public policy: a deep love for America and a desire to see it become more of a force for good. Other contributors include Nirupama Rao, a former Indian foreign secretary; Catherine Ashton, a former EU foreign-policy chief; Martin Kimani, a former Kenyan ambassador to the United Nations; and Jason Bordoff, a former energy policymaker in the Obama administration. The next White House—and American voters—would do well to heed their advice in mulling the difficult choices ahead.

There’s lots more in this issue, including a unique ranking of the world’s best international relations programs. No one can predict the state of the world in 2025, but here at Foreign Policy, we can at least help the next generation of policymakers figure out where to go to school.

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