Treasury, HHS Issue New Rules on Mental Health Parity
January 29, 2010 (PLANSPONSOR.com) - The U.S. Departments of Labor,
Health and Human Services (HHS), and the Treasury have jointly issued new
rules providing parity for consumers enrolled in group health plans who need
treatment for mental health or substance use disorders.
The new rules prohibit group health insurance plans — typically
offered by employers — from restricting access to care by limiting benefits and
requiring higher patient costs than those that apply to general medical or
surgical benefits. The rules implement the Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
A news release said the interim final rules were developed
based on the departments’ review of more than 400 public comments on how the parity
rule should be written. The deadline for issuing the rules was October 3, 2009,
but the departments took more time due to the number of comments received (see Regulators Pass Deadline for Guidance on Mental Health Parity).
According to the announcement, MHPAEA greatly expands on
an earlier law, the Mental Health Parity Act of 1996, which required parity
only in aggregate lifetime and annual dollar limits between the categories of
benefits and did not extend to substance use disorder benefits. The new law
requires that any group health plan that includes mental health and substance
use disorder benefits along with standard medical and surgical coverage must
treat them equally in terms of out-of-pocket costs, benefit limits, and
practices such as prior authorization and utilization review. These practices
must be based on the same level of scientific evidence used by the insurer for
medical and surgical benefits.
MHPAEA applies to employers with 50 or more workers whose
group health plans choose to offer mental health or substance use disorder
benefits. The new rules are effective for plan years beginning on or after July
1, 2010.
Comments on the interim final rules are still being
solicited. Sections where further
comments are being specifically sought include so-called "non quantitative"
treatment limits such as those that pertain to the scope and duration of
covered benefits, how covered drugs are determined (formularies), and the
coverage of step-therapies. Comments are
also being specifically requested on the regulation’s section on "scope of
benefits" or continuum of care.
Comments on the interim final regulation are due 90 days
after the publication date, and may be made on the federal rulemaking portal at
http://www.regulations.gov. Comments directed to HHS should include the
file code CMS-4140-IFC. Comments to the
Department of Labor should be identified by RIN 1210-AB30. Comments to the Treasury’s Internal Revenue
Service should be identified by REG-120692-09.
Comments may be sent
to any of the three departments and will be shared with the other departments.
Text of the interim final rules is here. Instructions for commenting are here. They will be published in the Federal Register for February 2, 2010.
PLANSPONSOR staff
editors@plansponsor.com