The United States Departments of Labor, Health and Human Services, and the Treasury have proposed rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (“the Act”) designed to ensure that health insurance plans comply with the Act’s requirements to provide benefits for mental health and substance use disorder care on parity with benefits for medical and surgical care.
Under the Act, health plans are prohibited from placing more restrictive Nonquantitative Treatment Limitations (“NQTLs”) on mental health and substance use disorder benefits than on medical and surgical benefits. In other words, health plans cannot limit access to mental health or substance use disorder benefits by placing limitations on coverage, such as pre-authorization requirements or step therapy, that are not required to access coverage for medical and surgical benefits.
The proposed rules are also designed to ensure that health plans have adequate in-network mental health providers.
Specifically, the new rules:
- Amend the existing NQTL standard to prevent plans from using NQTLs to place greater limits on mental health and substance use disorder benefits than on medical and surgical benefits
- Provide revised and new examples of what health insurers cannot do, such as imposing more restrictive utilization management policies and narrower networks, to make it harder for patients to access mental health and substance use disorder benefits
- Require health plans to collect and evaluate outcomes data to address differences in access to mental health and substance use disorder benefits as compared to medical and surgical benefits
- Codify the requirement that health plans conduct meaningful comparative analyses measuring the impact of NQTLs, including standards related to network composition and out-of-network reimbursement rates
- Add a rule governing network composition
- Require self-funded non-Federal governmental plans to comply with the Act
The Administration was prompted to issue the proposed rules in part because a recent Department of Labor review found that every health plan it reviewed had failed to implement the Act’s parity requirements.
In a press release announcing the proposed rules, Secretary of HHS Xavier Becerra stated: “HHS believes all Americans should have access to mental health and substance use disorder treatment, whenever and however they need it.”
Comments on the proposed rules are due 60 days from their publication in the Federal Register.
In a related action, the Administration sought comments on a technical release regarding proposed new data requirements for NQTLs. Comments on the technical release are due on October 2, 2023.
Whatley Kallas, LLP’s earlier article on the Department of Labor’s review of health plans’ implementation of the Act’s requirements is linked here.
The attorneys at Whatley Kallas will continue to follow the proposed rules as they are finalized and implemented.