Federal Agencies Announce Final Insurance Parity Rule

On Monday, September 9th the United States Departments of Labor (DOL), Health and Human Services (HHS) and Treasury released their anticipated final rule regarding mental health and substance use parity, Requirements Related to the Mental Health Parity and Addiction Equity Act (MHPAEA).

This rule implements and builds on the MHPAEA, providing additional protections against nonquantitative treatment limitations (NQTLs) for mental health and substance use disorder benefits as compared to medical/surgical (M/S) benefits. Examples of NQTLs include prior authorization requirements, numerical limits on visits, and standards related to network sufficiency and composition.

Importantly, the final rule also seeks to clarify and provide additional information needed for plans and issuers to meet their obligations under MHPAEA and for DOL, HHS, Treasury and states to enforce those obligations.

Among other things, these final rules:

  • Make clear that MHPAEA protects plan participants, beneficiaries, and enrollees from facing greater restrictions on access to MH/SUD benefits as compared to M/S benefits.
  • Reinforce that health plans and issuers cannot use NQTLs that are more restrictive than the predominant NQTLs applied to substantially all M/S benefits in the same classification. Examples of NQTLs include prior authorization requirements and other medical management techniques, standards related to network composition, and methodologies to determine out-of-network reimbursement rates.
  • Require plans and issuers to collect and evaluate data and take reasonable action, as necessary, to address material differences in access to MH/SUD benefits as compared to M/S benefits that result from application of NQTLs, where the relevant data suggest that the NQTL contributes to material differences in access.
  • Codify the requirement in MHPAEA, as amended by the Consolidated Appropriations Act, 2021, that health plans and issuers conduct comparative analyses to measure the impact of NQTLs. This includes evaluating standards related to network composition, out-of-network reimbursement rates, and medical management and prior authorization NQTLs.
  • Prohibit plans and issuers from using discriminatory information, evidence, sources, or standards that systematically disfavor or are specifically designed to disfavor access to MH/SUD benefits as compared to medical/surgical benefits when designing NQTLs.
  • Implement the sunset provision for self-funded non-Federal governmental plan elections to opt out of compliance with MHPAEA.

For more information, check out DOL’s one-pager for providers, news release, and fact sheet.