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Agencies Issue Final Regulations on Mental Health Parity Requirements


November 2013

The Departments of Treasury, Labor, and Health and Human Services (collectively, the “Agencies”) issued final regulations implementing the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. The rules generally require that health plans offering mental health/substance abuse disorder services offer parity of coverage between those services and medical/surgical services. That is, plans may not make the financial requirements (e.g., coinsurance, deductibles, and copayments) and treatment limitations (e.g., annual or lifetime limits or visit limits) for mental health/substance abuse disorder services more restrictive than medical/surgical services. 

The rules largely implement the interim regulations issued in February 2010. Like the interim regulations, the final regulations include the ACA-implemented rule that mental health/substance abuse disorder services are an essential health benefit (EHB) that must be offered by small group and individual non-grandfathered plans. However, a notable difference between the 2010 rules and the final rules is that the final rules provide that a plan may not impose a non-quantitative treatment limitation (NQTL) which is a limitation on the scope or duration of a treatment not expressed numerically (e.g., medical management technique such as prior authorization), on a mental health/substance abuse disorder treatment, unless it is applied no more stringently than it is to comparable medical/surgical services.

The final regulations apply for plan years beginning on or after July 1, 2014 (January 1, 2015 for calendar year plans).

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