On January 29, 2010, the Department of Labor (the “DOL”) added to its website a new Fact Sheet, which provides information on the Mental Health Parity and Addiction Equity Act of 2008 (the “MHPAEA”) . According to the Fact Sheet, the MHPAEA is generally effective for plan years beginning on or after October 3, 2009 (January 1, 2010 for calendar year plans). An interim final rule, which implements the provisions of the MHPAEA, will be published in the Federal Register on February 2, 2010. The regulation is effective on April 5, 2010, and applicable to plan years beginning on or after July 1, 2010. (A News Release of January 29, 2010 also announces that this regulation will be published.)
The Fact Sheet further indicates that, with respect to employers and their health plans:
• The MHPAEA requires group health plans to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (“MH/SUD”) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.
• The MHPAEA supplements prior provisions under the Mental Health Parity Act of 1996 (the “MHPA”), which required parity with respect to aggregate lifetime and annual dollar limits for mental health benefits (but not substance abuse benefits) . Regulations were issued under MHPA in 1997. The MHPAEA interim final rule amends and modifies certain provisions in the MHPA regulations.
• Although the MHPAEA provides significant new protections to participants in group health plans, it is important to note that MHPAEA does not mandate that a plan provide MH/SUD benefits. Rather, if a plan provides medical/surgical and MH/SUD benefits, it must comply with the MHPAEA’s parity provisions.
• The MHPAEA applies to plans sponsored by private and public sector employers with more than 50 employees, including self-insured as well as fully insured arrangements.
The Fact Sheet notes that, under the new regulation:
• If a plan offers medical/surgical and MH/SUD benefits and imposes “financial requirements” (such as deductibles, copayments, coinsurance and out of pocket limitations), the financial requirements applicable to MH/SUD benefits can be no more restrictive than the “predominant” financial requirements applied to “substantially all” medical/surgical benefits.
• The “predominant/substantially all” test applies to six classifications of benefits on a classification-by-classification basis. The regulation also includes other rules and definitions that are necessary in order for plans to apply this general parity test.
• Similar protection is provided for treatment limitations. “Treatment limitations” mean limits on the frequency of treatment, number of visits, days of coverage, or other similar limits on the scope or duration of treatment.
• The regulation clarifies that there may be both quantitative and non-quantitative treatment limitations, and provides rules for each. Since they are similar to financial requirements, quantitative treatment limitations are subject to the same general test as the financial requirements discussed above.
• Because non-quantitative treatment limitations (such as medical management standards, formulary design, and determination of usual/customary/reasonable amounts) apply differently, the regulation includes a separate parity requirement for them.