Last week we covered the Trump administration's plan to rewrite mental health parity rules. This week, they officially confirmed it. On March 30, the Department of Justice told a federal court that new parity regulations will be proposed by December 31, 2026. The details are still being written, but the direction is clear: the rules will be significantly weaker than Biden's version. For therapists on insurance panels and patients seeking care, this matters.
FOR THERAPISTS: Parity Rules Get Rewritten. Here's What Changes for Your Panels
The Biden administration's 2024 parity rule was designed to close a loophole that's existed for years. Insurance companies are required by law to cover mental health at the same level as medical care. But "same level" is vague. For decades, insurers interpreted this loosely, using stricter treatment limitations for therapy than for surgery or medication.
Biden's rule tried to fix this by requiring insurers to prove they weren't treating mental health differently. Specifically, they had to analyze their nonquantitative treatment limitations (NQTLs) for both types of benefits and show the analysis. NQTLs are things like prior authorization requirements, network restrictions, and session limits.
The Trump administration isn't defending Biden's rule in court. Instead, they're writing a new one with "significant revisions." Translation: it will be weaker and more favorable to insurers.
What this means for your practice:
First, claim denials may increase. Without stronger enforcement requirements, insurers have less incentive to approve mental health claims at the same rate as medical claims. You may see more denials for session limits, prior authorization, or "medical necessity" determinations.
Second, prior authorization is likely to stay complicated. The Biden rule tried to standardize PA requirements across medical and mental health. The new rule probably won't. Expect to keep fighting for approvals on cases that should be straightforward.
Third, network restrictions may get tighter. Insurers use network adequacy as a way to limit mental health access. Weaker parity enforcement means they can get away with smaller, more restrictive networks for therapy than for medical care.
The bigger picture: the insurance landscape for mental health is becoming less predictable and less favorable to providers. This is accelerating the shift toward private pay and hybrid models. If you've been considering a hybrid practice or private pay option, now is the time to start planning.
FOR PATIENTS: Understanding the Parity Rule Changes
If you're looking for a therapist or currently in therapy, you might be wondering what this policy change means for you. Here's the simple version.
Insurance companies are supposed to cover mental health the same way they cover medical care. But in practice, they often don't. They might require more approvals for therapy sessions, limit how many sessions you can have, or make it harder to find an in-network therapist than an in-network doctor.
The Biden administration tried to fix this by making insurers prove they weren't treating mental health differently. The Trump administration is now weakening those rules. That means insurers will have more flexibility to deny mental health claims and use stricter limits for therapy.
What this means for you:
If you're on an insurance plan, you might encounter more barriers to getting therapy. Your insurance company might deny more claims, require more approvals, or have a smaller network of in-network therapists.
The good news: parity law is still on the books. Insurers still have to cover mental health. But enforcement is weaker, which means you may need to be more persistent in appealing denials or advocating for yourself.
If you're having trouble getting approved for therapy, don't give up. Ask your therapist to help you appeal. If you're denied, you have the right to file a complaint with your state insurance commissioner or the Department of Labor.
Many therapists are also offering hybrid or private pay options, which can be a way to get consistent care without fighting with insurance. It's worth asking your therapist about their options.
QUICK LINKS
Trump administration parity rule update: KHI's coverage of the new proposed rule and what it means for enforcement.
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