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On September 9, the U.S. Departments of Labor, Health and Human Services, and the Treasury (collectively, the Departments) released a final rule to strengthen implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) (the Final Rule). The Departments say they aim to further the fundamental purpose of MHPAEA to ensure that health plan enrollees are not subject to greater restrictions when seeking mental health and substance use disorder (MH/SUD) benefits than when they seek medical/surgical (M/S) benefits. The Departments said they seek to address concerns that, despite 16 years of MHPAEA regulation, plan enrollees still often find it more difficult to access MH/SUD benefits than M/S benefits.
The Final Rule amends proposed regulations related to non-quantitative treatment limitations (NQTLs), such as utilization management, and provider contracting and reimbursement practices.
Notably, in the Final Rule, the Departments declined to finalize several significant and controversial proposed rule changes and made changes to other proposed rules. Specifically, the Departments did not finalize the proposed “no more restrictive” rule which established mathematical tests to determine whether an NQTL applied to MH/SUD benefits was no more restrictive than the predominate NQTL that applied to substantially all M/S benefits. In addition, the Departments did not finalize proposed exceptions for NQTLs based upon independent standards and measures to detect and prevent fraud and abuse as well as the special rule proposed for NQTLs related to network composition. The Departments also revised the proposed rules prohibiting discriminatory factors and evidentiary standards and the proposed rule requiring meaningful benefits.
The Final Rule also provides requirements related to the comparative analyses that plans and issuers are required to complete and document under MHPAEA, as amended by the Consolidated Appropriations Act, 2021.
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