Biden Administration Takes Action on Mental Health Parity Act Rulemaking

The Biden Administration has released an interim final rule to enforce the Mental Health Parity and Addiction Equity Act (MHPAEA).

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The rule addresses treatment limitations in mental health and substance use disorder benefits within group health plans.

Proposed Rule Targets Nonquantitative Treatment Limitations

The proposed rule prohibits nonquantitative treatment limitations (NQTLs) that unfairly restrict access to mental health and substance use disorder treatments.

NQTLs include tools like prior authorization requirements and step therapy, which can hinder access to needed treatments.

Data Collection and Analysis Requirements

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

This includes reviewing claims denials and NQTL-related data and assessing the impact of these limitations on plan benefits.

Mitigation of Disparities

Plans must take reasonable measures to address significant discrepancies in access to mental health and substance use disorder treatments if the data reveals disparities.

The goal is to rectify these differences and ensure equitable access to necessary care.

Network Composition Standards

The proposed rule also addresses NQTLs that impact network composition in group health plans.

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

Possible Presumptions of MHPAEA Violations

Substantial disparities in access to mental health and substance use disorder treatments could lead to presumptions of MHPAEA violations.

This emphasizes the importance of ensuring equal access within health plan networks.

Technical Release Provides Guidance

A technical release was issued alongside the proposed rule, offering additional guidance on data collection and evaluation related to NQTLs.

The release also suggests the potential for safe harbor provisions for NQTLs impacting network composition, potentially allowing compliant plans to avoid enforcement actions.

Public Comment Period

The proposed rule is currently open for a 60-day public comment period, allowing stakeholders to provide feedback.

This input will be taken into consideration as the rule is finalized.

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Report to Congress Highlights Enforcement Efforts

The Departments have presented a report to Congress detailing their prior enforcement efforts regarding NQTLs.

This report demonstrates an ongoing commitment to ensuring parity in mental health and substance use disorder treatment access.

Anticipated Future Guidance

Further guidance on MHPAEA is expected in the future, signaling continued efforts to promote equal access to mental health and substance use disorder treatments.

Stakeholders, including plans and issuers, should stay informed and assess their provisions for compliance with MHPAEA requirements.

Malik Graystone

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