11/14/13

Labor and Employment Alert: Mental Health Parity and Addiction Equity Act Parity Analysis is Fine Tuned

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Summary:  New final regulations under the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) apply to group health plans in plan years beginning on or after July 1, 2014 (January 1, 2015 for calendar year plans).  The regulations generally incorporate the 2010 interim final regulations and subsequent FAQs, with some notable clarifications:  

Background

A group health plan that covers both mental health/substance use disorder benefits and medical/surgical benefits must cover the mental health/substance use disorder benefits in parity with the medical/surgical benefits.  Generally, this means that the financial requirements (e.g., coinsurance, deductibles, out-of-pocket maximums) and treatment limitations (e.g., visit limits, days in a waiting period, days of coverage) that apply to mental health/substance use disorder benefits cannot be more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits. 

The MHPAEA parity analysis is conducted on a classification-by-classification basis, with six specific classifications identified: (1) inpatient/in-network; (2) inpatient/out-of-network; (3) outpatient/in-network; (4) outpatient/out-of-network; (5) emergency care; and (6) prescription drug.

New Final Regulations

The new final regulations retain the six classifications and confirm that mental health/substance use disorder benefits, and medical/surgical benefits, cannot be characterized outside of these six classifications for purposes of the MHPAEA parity analysis.

Some of the notable changes that were made from the 2010 regulations include: