On August 15, 2023, the Biden Administration made a significant move towards equal access to mental health and substance use disorder treatments. They released an interim final rule to enforce the Mental Health Parity and Addiction Equity Act (MHPAEA). This rule, jointly issued by the US Departments of Labor (DOL), Treasury (DOT), and Health and Human Services (HHS), aims to address treatment limitations that unfairly impact mental health and substance use disorder benefits compared to medical and surgical benefits in group health plans.
The proposed rule, which consists of nearly 400 pages, seeks to prevent health plans and issuers from using nonquantitative treatment limitations (NQTLs) to impose stricter access limits on mental health and substance use disorder benefits compared to medical and surgical benefits. NQTLs include various non-numerical tools such as prior authorization requirements and step therapy, which plans use to manage access to treatments. These limitations have been criticized for potentially hindering access to mental health and substance use disorder treatments.
The proposed rule introduces key provisions to rectify these disparities. Firstly, it mandates that plans and issuers collect and analyze data to ensure that NQTLs affecting mental health and substance use disorder benefits are not more restrictive than those for medical or surgical benefits. This includes reviewing claims denials, NQTL-related data, and the impact of NQTLs on plan benefits. If discrepancies in access to mental health and substance use disorder treatment benefits are found, plans must take reasonable measures to address these differences.
The rule also addresses NQTLs that impact network composition. Plans implementing such NQTLs must gather and evaluate data on in-network and out-of-network utilization rates, network adequacy metrics, and provider reimbursement rates. Substantial disparities in access could lead to presumptions of MHPAEA violations.
In addition to the proposed rule, a technical release was issued, providing further guidance on data collection and evaluation for NQTLs. The release also hinted at the possibility of future safe harbor provisions for NQTLs that impact network composition, potentially allowing compliant plans to avoid enforcement actions for two years.
The proposed rule is currently open for a 60-day public comment period to gather feedback from stakeholders. The Departments have also presented a report to Congress outlining their previous enforcement efforts concerning NQTLs. More guidance on MHPAEA is expected in the future, demonstrating ongoing efforts to ensure equal access to mental health and substance use disorder treatments.
It is advised that stakeholders, including plans and issuers, monitor these developments and assess their provisions for compliance with MHPAEA requirements.