- Interim Final Regulations on the Mental Health Parity and Addiction Equity Act of 2008 Released
- June 11, 2010
- Law Firm: Quarles Brady LLP - Milwaukee Office
On February 2, 2010, the Department of Labor, Department of Health and Human Services and the Department of the Treasury issued interim final regulations under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (“MHPAEA“). Group health plans that offer mental health or substance use disorder benefits are required to comply with the interim final regulations for plan years beginning on or after July 1, 2010. Calendar year plans will need to comply with the interim final regulations beginning January 1, 2011. Delayed effective dates apply for collectively bargained plans. The MHPAEA does not apply to employers with less than 50 employees during the preceding calendar year.
The MHPAEA does not require group health plans to offer mental health or substance use disorder benefits. However, plans that offer these benefits must provide parity between mental health and/or substance use disorder benefits and medical/surgical benefits. Under the MHPAEA and the interim final regulations, the financial requirements (such as deductibles and copayments) and treatment limitations (such as number of visits) that are applicable to mental health and/or substance use disorder benefits can be no more restrictive than the predominant financial requirements and treatment limitations that apply to substantially all medical/surgical benefits in the same classification. The six classifications of benefits are: inpatient, in-network; inpatient, out-of-network; outpatient, in-network; outpatient, out-of-network; emergency care and prescription drugs. A financial requirement or treatment limitation is predominant if it applies to more than one-half of the medical/surgical benefits subject to the financial requirement or treatment limitation in a classification. A financial requirement or treatment limitation applies to substantially all medical/surgical benefits in a classification if it applies to at least two-thirds of the benefits in that classification. The interim final regulations clarify that plans must use a single deductible and out-of-pocket maximum for both mental health and substance use disorder benefits, and medical/surgical benefits. Additionally, any processes, strategies or evidentiary standards (such as preauthorization) used in applying treatment limitations to mental health and/or substance use disorder benefits must be comparable to, and can be applied no more stringently than, the processes and strategies that apply to medical/surgical benefits in the same classification.
Q&B Key: Sponsors of group health plans that offer mental health or substance use disorder benefits should review their plans to ensure that they comply with the interim final regulations. If your company sponsors an insured plan, you should speak with your company's insurance provider about compliance with the regulations.