On November 13, 2013, the Departments of Health and Human Services (HHS), Labor, and the Treasury published a joint final rule implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The MHPAEA requires group health insurance plans to provide parity between mental health or substance use disorder benefits and medical/surgical benefits with respect to financial requirements (e.g., copayments and deductibles) and treatment limitations. The MHPAEA's statutory provisions generally were effective for plan years beginning after October 3, 2009. Interim final rules published February 2, 2010 generally became applicable for plan years beginning on or after July 1, 2010.
The November 13, 2013 final rule builds on the interim rule and additional clarifications subsequently issued by the Departments, and provides clarification of provisions intended to strengthen consumer protections. For instance, the final rule removes an interim final rule exception to the nonquantitative treatment limitations (NQTL) requirements ''to the extent that recognized clinically appropriate standards of care may permit a difference." The Departments note that while the regulations do not require plans and issuers to use the same NQTLs (e.g., medical management techniques like prior authorization) for both mental health and substance use disorder benefits and medical/surgical benefits, the processes, strategies, evidentiary standards, and other factors used to determine whether and to what extent a benefit is subject to an NQTL must be comparable to and applied no more stringently for mental health or substance use disorder benefits than for medical/surgical benefits. In addition, the final rule: clarifies the applicability of parity requirements to intermediate levels of care received in residential treatment or intensive outpatient settings; addresses the scope of the transparency required by health plans; and provides that plan or coverage restrictions based on geographic location, facility type, provider specialty, and other criteria that limit the scope or duration of benefits for services must comply with the NQTL parity standard. The November 13 final rule generally applies to plan years beginning on or after July 1, 2014; until then plans and issuers subject to MHPAEA must continue to comply with the interim final rules.
Note that the Affordable Care Act (ACA) separately includes mental health and substance use disorder services as an "essential health benefits" category that must be provided by health plans offered in the individual and small group markets beginning in 2014.
This article is presented for informational purposes only and is not intended to constitute legal advice.
