Comply with the rules or go beyond them?
The U.S. Departments of the Treasury, Labor, and Health and Human Services issued final regulations on November 8, 2013, implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Although interim final rules (IFR) had been in effect since 2010, the industry has been awaiting these final rules in order to gain clarity on how to comply with certain provisions of MHPAEA.
Although initially applicable only to fully insured or self-funded health plans offered by large employers (over 50 employees), as a result of provisions in the Patient Protection and Affordable Care Act (ACA), MHPAEA and the IFR will also apply to the individual and fully insured small group markets, for policy years beginning on or after January 1, 2014. The new final rules, which are effective for plan years starting on or after July 1, 2014, will therefore affect almost all commercially insured lives in the country. The rules do not apply to Medicare or to Medicaid managed care plans, although the latter are covered by MHPAEA (but still without specific implementing regulations, five years after enactment of the law).
The new rules clarify or revise some aspects of the IFR that had created unusual consequences for employers and health plans. They also make several important changes to the rules regarding nonquantitative treatment limitations (NQTLs), but stop short of laying out a mathematical compliance test for NQTLs. The 2010 IFR was silent on the question of what scope of behavioral healthcare services must be provided to be compliant; the new regulations address the question but still leave some ambiguity. A number of important elements of the IFR, such as the basic framework for testing compliance on financial requirements and quantitative treatment limitations, were left unchanged.
This briefing paper presents the key changes to the regulations codified in the final rules and discusses the implications for employers and health plans. For an overview of the 2010 IFR, see the Milliman healthcare reform briefing paper, “Implementing Parity: Investing in Behavioral Health.”1