The Departments of Labor, Health and Human Services, and the Treasury issued final rules on Sept. 9 to clarify and strengthen protections that expand equitable access to mental health (MH) and substance use disorder (SUD) care.
These rules build on the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA), which requires employer-sponsored and private health insurance to offer MH or SUD benefits to cover those benefits in parity with medical and surgical (M/S) benefits.
The new rule also clarifies that plans:
- Cannot use nonquantitative treatment limitations (NQTLs) that are more restrictive than the predominant NQTLs applied to M/S benefits in the same classification
- Must collect and evaluate data and act to mitigate differences in access to MH and SUD benefits compared with M/S benefits that result from application of NQTLs
- Must conduct comparative analyses to measure the impact of NQTLs, including evaluating network composition standards, out-of-network reimbursement rates, and medical management and prior authorization NQTLs
- Are prohibited from using discriminatory information that systematically disfavors or is specifically designed to disfavor access to MH and SUD benefits compared with M/S benefits when designing NQTLs
The final rules end the ability of self-funded nonfederal plans to opt out of MHPAEA requirements as outlined in the CAA, 2023.
CMS Seeks Comment on MHPAEA Compliance Templates
CMS seeks preliminary feedback on a new set of templates and instructional guides for state agencies to document mental health and SUD benefits provided through a state’s Medicaid and Children’s Health Insurance (CHIP) programs. These guides ensure that benefits comply with Medicaid and CHIP MHPAEA final rule requirements; CMS will consider feedback before finalizing these tools. Submit comments via email to MedicaidandCHIP-Parity@cms.hhs.gov by Oct. 29.
This comes after the Center for Medicaid and CHIP Services on June 12 issued an informational bulletin with guidance on reporting Medicaid managed care and CHIP compliance with MH and SUD parity requirements.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.