Final Rules Released on Mental Health Parity Act

Federal agencies, including the Treasury Department, the Department of Labor and the Department of Health and Human Services, have issued final rules for providing parity to group health plan participants who receive treatment for mental health and substance abuse disorders. The interim final rules were published in the February 2, 2010 Federal Register and apply to plan years starting after June 30, 2010. The new rules will require many employers to make additional modifications to their medical plans.

The new rules provide employers and insurers with long-awaited clarification and guidance on complying with the Paul Wellstone and Pete Dominici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Among the key clarifications provided in the new rules is a breakdown of benefits into six categories:

• Inpatient in network
• Inpatient out of network
• Outpatient in network
• Outpatient out of network
• Emergency care
• Prescription drugs

The rules require that mental health and/or substance abuse benefits provided in any one of these categories must be on par with other medical and surgical benefits in that category. The rules further clarify “parity” to mean that plans may not impose more restrictive financial requirements (e.g., deductibles, copayments, out-of-pocket maximums) or treatment limitations (e.g., number of visits) on mental health/substance abuse care than the predominant financial requirements and limitations imposed on other services in the same category.

When MHPAEA was first enacted in 2008, many employers removed specific day and visit limitations that applied only to mental health treatments. However, many have maintained separate deductibles and out-of-pocket maximums for these benefits. The new rules prohibit plans from including “separate but unequal deductibles and maximums,” which will require many employers to modify their plan designs.

Contact Cindy LaQuatra, RHU a Senior Consultant within the Health & Wellness department at BRG for assistance in reviewing your plan and ensuring it complies with the new rules. You can reach Cindy by phone at 216-393-1848 or by email at claquatra@benefitsrg.com.