ERISA and Global Benefits

Federal Government Issues Final Rules Governing Mental Health and Substance Abuse Parity

January 23, 2014

The Global Compensation, Benefits & ERISA Practice Group

The Departments of Treasury, Labor, and Health and Human Services recently issued final rules under the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and the Affordable Care Act.  The MHPAEA requires group health plans, and both group and individual insurance policies, to provide equivalent financial terms (e.g. copayments, deductibles, etc.) and treatment limitations for mental health and substance abuse as they do for treatments relating to physical health and surgical care.  

Highlights of the final rules include the following.  They:

• Apply parity to intermediate levels of care (by requiring identification of intermediate services for mental health and substance abuse care, and then mandating comparable treatment);

• Apply parity to all group health plan standards, including geographic location, facility type, provider specialty, and other criteria that could limit the scope or duration of benefits;

• Eliminate an exception from the parity rules for mental health and substance abuse treatment based on “clinically appropriate standards of care;” and

• Clarify the disclosure rights of participants with respect to mental health and substance abuse benefits.

The final rules apply to group health plan years beginning on or after July 1, 2014, so employers should prepare accordingly for timely compliance.  Certain exceptions apply for small group health plans, plans grandfathered under the Affordable Care Act, self-insured state and local government plans, retiree-only plans, and plans qualifying for the increased cost exemption under the MHPAEA.

For more detail on the requirements, see the full final rules, as published in the Federal Register, Vol. 78, No. 219.   See also the “FAQs About Affordable Care Act Implementation (Part XVII) and Mental Health Parity Implementation.”