MHPAEA's Proposed Rule Changes

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A significant new mental health parity rule has been proposed by the Departments of Labor, Treasury, and Health and Human Services, indicating a substantial shift in enduring mandates towards improving mental health care in the United States. The proposed rule is designed to strengthen the Mental Health Parity and Addiction Equity Act (MHPAEA), a landmark legislation that aims to prevent group health plans and health insurance issuers from imposing less favorable benefits for mental health and substance use disorders compared to medical/surgical benefits.

This enhancement is achieved through the introduction of a comprehensive, three-part analysis procedure that plan sponsors must undertake to certify parity relating to non-quantitative treatment limitations or requirements (NQTLs). NQTLs include restrictions based on the frequency of treatment, the facility type, and the criteria for medical necessity determinations. The proposed rule not only provides a clear and operational compliance roadmap for plan sponsors but also sets objective benchmarks to guarantee the parity of a plan's NQTLs, ensuring that these limitations or requirements are applied equally to both mental health/substance use disorder benefits and medical/surgical benefits.

Employers are now encouraged, more than ever, to proactively examine their current schemes for adherence to the updated MHPAEA requirements. This entails ensuring that their carriers or third-party administrators not only uphold their fiduciary status but also rigorously adhere to their MHPAEA obligations. It's crucial for employers to remain vigilant of any potential pitfalls or contentious provisions in their plans, ensuring that a robust Comparative Analysis is in place to demonstrate compliance with the new regulations.

The proposed rule introduces a rigorous three-part analysis that plan sponsors must conduct. This analysis verifies if a plan's application of an NQTL on mental health and substance use disorder benefits is in strict alignment with parity requirements. Furthermore, the rule updates key definitions and introduces a practical 'meaningful benefit' requirement, which aims to ensure that plan beneficiaries receive tangible benefits from the parity regulations. It also removes the option for self-funded non-federal governmental plans to opt out of MHPAEA compliance, closing a significant loophole that previously allowed some plans to bypass these critical mental health protections.

Assuming the proposed rule receives approval, it would come into effect for group health plans and health insurance issuers offering group or individual health insurance coverage from the first day of the first plan year, starting from January 1, 2025. To facilitate a transparent rule-making process, the Departments have opened the floor for public comments on the proposed rule until October 2, 2023. This period of public comment is crucial for gathering insights and feedback from all stakeholders involved, including employers, healthcare providers, insurance companies, and the general public.

The proposed rule, complemented by the MHPAEA report to Congress, underscores the continuous endeavors by federal agencies to enforce the MHPAEA rigorously. It also highlights an ongoing commitment to enhance mental health care and accessibility across the country. In light of these developments, employers are advised to stay abreast of updates related to this proposed rule. They should be ready to deduce and incorporate the final rule's requirements into their health plans once it takes effect, ensuring that they contribute positively to the broader goal of achieving mental health parity.

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