Final Regulations Issued for Mental Health and Addiction Parity

HHS, jointly with the Departments of Labor and Treasury, issued a final rule implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) (P.L. 110-343, secs. 511-12). The final rule, which will be published on November 13, ensures that health plans features like co-pays, deductibles and visit limits are generally not more restrictive for mental health/substance abuse disorders benefits than they are for medical/surgical benefits. The mental health parity provisions of the final regulation apply to group health plans for plan years (or, in the individual market, policy years) beginning on or after July 1, 2014.

Parity

MHPAEA was passed in 2008, and is generally effective for plan years beginning after October 3, 2009. MHPAEA requires large employer-based health insurance plans to cover treatment for psychiatric illnesses and substance-abuse disorders in the same way that they cover treatment for diseases like cancer. MHPAEA prevents large group health plans from imposing annual or lifetime dollar limits on mental health or substance use disorder benefits that are less favorable than any such limits imposed on medical/surgical benefits. The Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) builds on MHPAEA, requiring coverage of mental health and substance use disorder services as one of ten essential health benefits categories. Under the essential health benefits rule, individual and small group health plans are required to comply with these parity regulations.

Final Rule

This is the first final regulation issued under MHPAEA. An interim final rule was published in 2010, but the 5,400 comments received during the notice-and-comment period for the final rule were never addressed until now. The final rule includes consideration of and responses to the comments submitted by the public. The rule applies parity to intermediate levels of care received in residential treatment or intensive outpatient settings and eliminates a provision allowing insurance companies to make an exception for certain benefits based on “clinically appropriate standards of care.” It also clarifies that parity applies to all plan standards, including geographic limits, facility-type limits, and network adequacy, as well as clarifying the scope of transparency required by health plans, including plan participants’ disclosure rights.