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Biden Administration Implements Mental Health Parity Act Rulemaking to Address Treatment Limitations

On August 15, 2023, the Biden Administration took a significant step toward ensuring equitable access to mental health and substance use disorder treatments by releasing an interim final rule aimed at enforcing the Mental Health Parity and Addiction Equity Act (MHPAEA). The rule, jointly issued by the US Departments of Labor (DOL), Treasury (DOT), and Health and Human Services (HHS), is designed to curtail treatment limitations that disproportionately affect mental health and substance use disorder benefits in comparison to medical and surgical benefits within group health plans.

The proposed rule, encompassing nearly 400 pages, seeks to prohibit the use of nonquantitative treatment limitations (NQTLs) by health plans and issuers to impose more restrictive access limits on mental health and substance use disorder benefits than on medical and surgical benefits.

Credit: DepositPhotos

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NQTLs encompass various non-numerical tools, such as prior authorization requirements and step therapy, that plans employ to manage access to treatments.

These limitations have been criticized for their potential to unjustly hinder access to mental health and substance use disorder treatments.

The proposed rule introduces several key provisions aimed at rectifying these disparities:

1. Data Collection and Analysis: The rule mandates that plans and issuers collect and analyze data to ensure that NQTLs affecting mental health and substance use disorder benefits are not more restrictive than those for medical or surgical benefits.

This involves reviewing claims denials, NQTL-related data, and the impact of NQTLs on plan benefits.

2. Mitigation of Disparities: If the data reveals significant discrepancies in access to mental health and substance use disorder treatment benefits, plans must take reasonable measures to address these differences.

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3. Network Composition Standards: The rule also addresses NQTLs impacting network composition.

Plans implementing such NQTLs must gather and evaluate data on in-network and out-of-network utilization rates, network adequacy metrics, and provider reimbursement rates.

Substantial disparities in access could lead to presumptions of MHPAEA violations.

In conjunction with the proposed rule, a technical release was issued, providing additional guidance on data collection and evaluation related to NQTLs.

The release also hinted at the possibility of future safe harbor provisions for NQTLs affecting network composition, potentially allowing compliant plans to avoid enforcement actions for two years.

The proposed rule is currently open for a 60-day public comment period, during which stakeholders can provide feedback.

Additionally, the Departments have presented a report to Congress, highlighting their prior enforcement efforts concerning NQTLs.

Further MHPAEA guidance is anticipated in the future, signaling ongoing efforts to ensure parity in mental health and substance use disorder treatment access.

Stakeholders, including plans and issuers, are advised to monitor the ongoing developments and proactively assess their provisions for compliance with the MHPAEA requirements.

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Malik is a skilled writer with a passion for news and current events. With their keen eye for detail, they provide insightful perspectives on the latest happenings. Stay informed and engaged!