Federal Government Issues Interim Final Regulations on MHPAEA

On Friday, January 29, the Departments of Health and
Human Services, Labor and Treasury jointly issued significant new
interim final regulations for implementing the Paul Wellstone and Pete
Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

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The
regulations are 154 pages long and will require detailed reviews of
applicable plan documents and insurance policies, as well as current
processes regarding management of mental health benefits, claims, and
the relationship Plans have with outside organizations that provide and
manage mental health and substance abuse benefits.

These
are "interim” final regulations, meaning that they are essentially
final but are nonetheless subject to later changes as the result of the
official 90-day public comment period.

For
purposes of enforcement, regulators have emphasized that they will take
into account a health plan’s good faith efforts to comply with a
reasonable interpretation of the statute for violations that may occur
with implementations by the original Act deadline (plan year renewals
on or after October 3, 2009). The interim final regulation generally
applies to group health plans and health insurance issuers for plan
years beginning on or after July 1, 2010. Collective bargaining
entities have a different applicability provision to align with their
agreements.

The interim final rules
provide substantial clarification as to the definitions and tests that
must be used in establishing parity between mental health and substance
use and medical/surgical benefits with respect to financial
requirements and treatment limitations, as required under MHPAEA.