HHS, DOL and IRS have issued final FAQs on the implementation of the requirements of the Mental Health Parity and Addiction Equity Act (“MHPAEA”).
The MHPAEA requires that the financial requirements (e.g., coinsurance and copays) and treatment limitations ( e.g., visit limits) imposed on mental health or substance use disorder (“MH/SUD”) benefits cannot be more restrictive than the predominant financial requirements and treatment limitations that apply to substantially all medical/surgical benefits in a classification. The six classifications of benefits defined in final rules implementing the requirements of the MHPAEA are: (1) inpatient, in-network; (2) inpatient, out-of-network; (3) outpatient, in-network; (4) outpatient, out-of-network; (5) emergency care; and (6) prescription drugs.
With regard to any non-quantitative treatment limitation (“NQTL”), the MHPAEA final regulations provide that a group health plan or health insurance issuer may not impose a NQTL with respect to MH/SUD benefits in any classification unless, under the terms of the plan (or health insurance coverage) as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to MH/SUD benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation to medical/surgical benefits in the same classification.
According to the agencies, “[T]hese FAQs do not contain any new interpretations of MHPAEA, but instead provide additional examples of how the MHPAEA final regulations apply to different fact patterns to promote compliance.”
The MHPAEA also imposes certain disclosure requirements on group health plans and health insurance issuers with regard to the criteria for medical necessity determinations with respect to MH/SUD benefits. The FAQs provide a model disclosure form that may be used to meet this requirement.
The FAQs and model disclosure form can be found by clicking here.