Mental Health Parity Regulations Released

They’re here! The long anticipated regulations for the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) were released this morning. In the coming days we will be closely analyzing the interim rule and getting you more information on what we can expect for implementation of MHPAEA. In the meantime, I have attached a fact sheet released by the three Departments issuing the regulations and have highlighted a few further points of interest. I have also included a link to the regulations for your review.

Effective Dates: The Departments of Health and Human Services (HHS), Labor (DOL), and the Treasury released interim rules this morning, and they will be published to the Federal Register on Tuesday, February 2, 2010. The regulations become effective on April 5, 2010 and apply to plan years beginning on or after July 1, 2010. Since the law has been in effect since October 3, 2009, plans should currently be making best faith efforts to comply with the intent of the law.

Opportunity to Comment: The regulations released today are interim final rules, so there will be one more opportunity to comment on them before the final rule is released. (Note: Even if the final rule is not released by July 1, 2010, plans must comply with the interim final rule.) The attached fact sheet contains some of the areas on which the Departments especially want feedback. We will be preparing comments and will share them with the field. The comment period is open immediately and will close on May 3, 2010.

Six Classifications: The regulations clarify that the parity requirements will be applied against “substantially all” medical/surgical benefits in six classification areas. Those six classifications are inpatient/in-network, inpatient/out-of-network, outpatient/in-network, outpatient/out-of-network, emergency department, and prescription drugs. Plans offering mental health and substance use coverage must provide parity in all classification areas where medical/surgical benefits are offered.

Quantitative v. Non-quantitative Treatment Limitations: The regulations distinguish between quantitative and non-quantitative treatment limitations. Quantitative treatment limitations include frequency of treatment, number of visits, and days of coverage, and must be at parity with substantially all medical/surgical benefits. The Departments give separate guidance with examples of parity with medical/surgical benefits for non-quantitative treatment limitations like medical management and utilization management. We will be reviewing the non-quantitative treatment limitations guidance to ensure that the regulations cover all scenarios where treatment can be limited by these types of mechanisms.

Deductibles: Deductibles for mental health and substance use benefits cannot be separate from medical/surgical benefits. Mental health and substance use benefits and medical/surgical benefits must have combined deductibles for financial restrictions and quantitative treatment limitations.

Mental Health as a Non-specialty: Mental health and substance use benefits will not be treated as a specialty, but must be at parity with the predominant medical/surgical non-specialty benefits offered by an insurance plan.

Medicaid Managed Care Organizations (MCOs): While the MHPAEA applies to Medicaid managed care plans, the regulations released today do not. Separate rules for Medicaid MCOs will be released by CMS. We will monitor the release of those rules and update you when they are available.

Non-compliance and Complaints: The Departments are tracking non-compliance and complaints, as well as fielding questions about the regulations. We will send the information on how to determine compliance, file a complaint, and obtain further guidance from the Departments. MHA is also tracking non-compliance and benefit terminations, so please send examples of these to me at ssteverman@mentalhealthamerica.net.

Regulations Link: http://www.federalregister.gov/OFRUpload/OFRData/2010-02167_PI.pdf.

We will have more information and analysis for you in the next several days and weeks. We will also continue to update you on our public education and advocacy campaigns around the implementation of MHPAEA, and look forward to working closely with our affiliates on these initiatives.