{"id":5534,"date":"2023-09-27T07:41:20","date_gmt":"2023-09-27T12:41:20","guid":{"rendered":"https:\/\/blogs.luc.edu\/compliance\/?p=5534"},"modified":"2023-09-27T07:41:20","modified_gmt":"2023-09-27T12:41:20","slug":"new-mental-health-parity-rules-on-the-horizon","status":"publish","type":"post","link":"https:\/\/blogs.luc.edu\/compliance\/?p=5534","title":{"rendered":"New Mental Health Parity Rules on the Horizon"},"content":{"rendered":"

Sean McBride<\/em><\/span><\/p>\n

Associate Editor<\/em><\/span><\/p>\n

Loyola University Chicago School of Law, JD 2025<\/em><\/span><\/p>\n

On July 25, 2023, the Departments of Labor, Health and Human Services, and the Treasury (the agencies) proposed new rules<\/a> placing heightened compliance standards on health insurers and plans regarding the use of Non-Quantitative Treatment Limitations (NQTLs) for mental health and substance abuse disorder (MHSUD) services. These new rules amend the current reporting requirements with the intent to establish ongoing reporting that more clearly demonstrates whether MHSUD services are provided in compliance with the law.<\/span><\/p>\n

<\/p>\n

History of Mental Health Parity Regulation<\/strong><\/span><\/p>\n

In 2008, Congress passed the Pall Wellstone and Peter Domenici Mental Health Parity and Addiction Equity Act<\/a> (MHPAEA). The MHPAEA requires health insurers to cover mental health and substance abuse treatment no differently than medical and surgical treatment. The scope of the MHPAEA was expanded<\/a> to apply to individual health plans when the Affordable Care Act (ACA) was passed in 2010.<\/span><\/p>\n

In 2021, Congress passed the Consolidated Appropriations Act<\/a> (CAA), which required health insurers and plans to perform comparative analysis to prove that NQTLs \u2013 if applied \u2013 were being applied equally between MHSUD services and medical \/ surgical services.<\/span><\/p>\n

NQTLs are non-numerical limits on the scope or duration of health benefits. One of the most common NQTLs is a pre-authorization requirement for prescription drug coverage. For instance, there may be specific prescriptions that a health insurer will not cover until it\u2019s reasonably certain that it\u2019s safe for the insured person to take the medication. The health insurer may require results from a blood test before approving coverage.<\/span><\/p>\n

In the 15 years that the MHPAEA has been in place, insurers and employers have struggled to establish effective compliance. These issues are one of the primary reasons the new rules are being proposed. Ultimately, the goal is to provide a clearer path for insurers to remain in compliance.<\/span><\/p>\n

The Proposed New Rules<\/strong><\/span><\/p>\n

\u00a0<\/strong><\/span>The proposed new rules have three significant<\/a> updates to MHPAEA compliance reporting.<\/span><\/p>\n

    \n
  1. Under the new rules, health insurers and plans must include eating disorders and autism spectrum disorders within their overall definition of MHSUD.<\/span><\/li>\n
  2. Health insurers and plans must perform a comparative analysis on all NQTLs imposed on MHSUD services. If insurers fail to provide this reporting, they will be barred from imposing the NQTL until they can demonstrate compliance with the MHPAEA or a remedy to the violation. <\/span><\/li>\n
  3. If a health insurer plans to impose an NQTL on MHSUD benefits, the following three requirements must be met:<\/span><\/li>\n<\/ol>\n