Agencies Seek Comment on Mental Health Parity and Addiction Equity Act

A number of federal agencies including the Department of Labor’s (DOL) Employee Benefits Security Administration (EBSA) are requesting information in advance of a future rulemaking on group health plans. Specifically, the EBSA’s Request for Information (RFI) seeks input on questions related to the mental health parity provisions made by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The RFI was published in the April 28, 2009 edition of the Federal Register.

As stated in an EBSA press release about this request, the MHPAEA – among other things – creates new rules for any financial requirement (e.g., cost-sharing) or treatment limitations (e.g., visit limits) on mental health and substance use disorder benefits so that they are no more restrictive than predominant requirements or limitations applied to substantially all medical and surgical benefits covered by a plan. MHPAEA also reauthorized several provisions relating to parity in annual and lifetime dollar limits for group health plan coverage enacted as part of the Mental Health Parity Act (MHPA) of 1996.

The RFI seeks public comment to assist in the development of MHPAEA regulations, and to perform a cost-benefit analysis of initiating this proposed rulemaking. To that end, the EBSA has posed a number of questions, including the following:

  • What policies, procedures or practices of group health plans and health insurance issuers may be impacted by MHPAEA? What direct or indirect costs or benefits would result, and to whom?
  • Are there unique costs and benefits for small entities subject to MHPAEA (that is, employers with greater than 50 employees that maintain plans with fewer than 100 participants)? What special consideration, if any, is needed for these employers or plans? What costs and benefits have issuers and small employers experienced in implementing parity under state insurance laws or otherwise?
  • Are there additional paperwork burdens related to MHPAEA compared to those related to MHPA 1996, and, if so, what estimated hours and costs are associated with those additional burdens?
  • How do plans currently apply financial requirements or treatment limitations to (1) medical and surgical benefits and (2) mental health and substance use disorder benefits? Are these requirements or limitations applied differently to both classes of benefits? Do plans currently vary coverage levels within each class of benefits?
  • What terms or provisions require additional clarification to facilitate compliance? What specific clarifications would be helpful?
  • What information, if any, regarding the criteria for medical necessity determinations made under the plan (or coverage) with respect to mental health or substance use disorder benefits is currently made available by the plan? To whom is this information currently made available and how is it made available? Are there industry standards or best practices with respect to this information and communication of this information?
  • Which aspects of the increased cost exemption, if any, require additional guidance?

Comments responding to the MHPAEA RFI must be submitted on or before May 28, 2009. Written comments may be addressed to the U.S. Department of Labor, Office of Health Plan Standards and Compliance Assistance, Employee Benefits Security Administration, N-5653, 200 Constitution Avenue N.W., Washington, D.C. 20210, Attn: MHPAEA Comments. Comments may also be submitted electronically by email to E-OHPSCA.EBSA@dol.gov or through the federal e-rulemaking portal at www.regulations.gov.

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.