Information contained in this publication is intended for informational purposes only and does not constitute legal advice or opinion, nor is it a substitute for the professional judgment of an attorney.
The Departments of Labor, Treasury, and Health and Human Services have released final rules implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which requires parity between mental health or substance use disorder benefits and medical/surgical benefits with respect to financial requirements and treatment limitations under group health plans and group and individual health insurance coverage.
While the changes made by MHPAEA generally took effect for plan years beginning after October 3, 2009, the Affordable Care Act (ACA) made a number of changes to the MHPAEA requirements. Notably, as explained in the Federal Register notice, the ACA, among other things, extended the MHPAEA restrictions to the individual health insurance market. In addition, the ACA rules regarding essential health benefits (EHB) require health insurance issuers offering non-grandfathered health insurance coverage in the individual and small group markets to comply with the requirements of the MHPAEA regulations in order to satisfy the EHB requirement.
On February 2, 2010, the agencies issued interim final rules that, among other things, established six classifications of benefits and provided that the parity requirements be applied on a classification-by-classification basis; established restrictions on applying cumulative financial or quantitative treatment limitations to mental health benefits; and set forth certain disclosure requirements.
The final rules – to be published in the November 13, 2013 edition of the Federal Register – address comments made in response to the interim rules, incorporate clarifications issued by the agencies through FAQs since the issuance of the interim final regulations, and provide new clarifications on issues such as nonquantitative treatment limitations (NQTLs) and the increased cost exemption. Finally, the rules implement the provisions of MHPAEA affecting the individual health insurance market.
The revisions made by this final rule apply to group health plans and health insurance issuers for plan (or policy) years beginning on or after July 1, 2014. Plans are permitted to rely on the previously-published interim final regulations until the final rules become applicable.
A more detailed analysis of these final rules is forthcoming. In the interim, the DOL has posted online FAQs about how the ACA impacts the Mental Health Parity Implementation.
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