CMS, EBSA, and IRS Releases Final Rule on Requirements Related to the Mental Health Parity and Addiction Equity Act
On Sept. 13, 2024, the Internal Revenue Service (IRS), Employee Benefits Security Administration (EBSA), and Centers for Medicare & Medicaid Services (CMS) (collectively, the Departments) released a Final Rule on Requirements Related to the Mental Health Parity and Addiction Equity Act (Final Rule). The Final Rule will be published in the Federal Register on Sept. 23, 2024.
- The Final Rule is being issued to provide greater clarity on what health plans and issuers must do to comply with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The Final Rule:
- Clarifies that plans and issuers cannot impose greater restrictions on access to mental health and substance use disorder (MH/SUD) benefits as compared to medical/surgical benefits.
- Reinforces that health plans and issuers cannot use nonquantitative treatment limitations (NQTLs) (including prior authorization and utilization management, network composition standards, and out-of-network reimbursement rate methodologies) for MH/SUD benefits, that are more restrictive than the predominant NQTLs applied to medical/surgical benefits in the same classification.
- Requires plans and issuers to assess material differences in access to MH/SUD benefits as compared to medical/surgical benefits and then take reasonable action if the data suggests that the NQTL contributes to such access differences.
- Requires health plans and issuers to measure the impact of NQTLs by conducting comparative analyses to evaluate standards for network composition, out-of-network reimbursement rates, medical management, and prior authorization NQTLs.
- Prohibits plans and issuers from using discriminatory information, evidence, sources, or standards that systematically disfavor or are designed to disfavor access to MH/SUD benefits when designing NQTLs.
- Provides examples to clarify and illustrate the requirements of MHPAEA.
- Implements the sunset provision for self-funded non-Federal governmental plan elections to opt out of compliance with MHPAEA.
For questions, please reach out to Vicky Jucelin.
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