OLR Report 2013-R-0437 summarizes the final regulations implementing the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The act and the final regulations require parity between mental health and substance use disorder benefits and medical and surgical benefits with regard to financial requirements (e.g., co-payments) and treatment limitations under group health insurance plans, and group, and individual health insurance coverage. The final regulations also reflect changes the federal Patient Protection and Affordable Care Act (ACA) made to the health insurance market. (For related information, see OLR Report 2013-R-0086 on mental health parity.)
Among other things, the final regulations establish transparency requirements for health insurance plans, including disclosure rights of plan participants and providers. In most cases, they require that co-payments, deductibles, and limits on visits to health care providers be no more restrictive or less generous for mental health and substance use disorder benefits than for medical and surgical benefits. They also restrict the use of nonquantitative treatment limitations such as prior authorization requirements.
Under the final regulations, the parity requirements apply to all plan standards, including geographic limits, facility-type limits, and network adequacy. They also apply to intermediate levels of care received in residential treatment or intensive outpatient settings.
The final regulations provide for temporary exemptions from their requirements for insurance plans if they cause the cost of a plan to increase by specified amounts. The final regulations do not apply to Medicaid managed care plans, alternative benefit plans (e.g., Medicaid expansion plans under the ACA), or the Children's Health Insurance Program.
The U.S. departments of Health and Human Services (DHHS) and Labor (DOL) and the Internal Revenue Service issued the final regulations on November 13, 2013, after reviewing more than 5,400 public comments on the interim final regulations, which had been issued in 2010.
The mental health parity provisions of the final regulations apply to health plans and health insurance issuers for plan years (policy years in the individual market) beginning on or after July 1, 2014. Certain technical amendments are effective December 13, 2013.
For more information, read the full report.
