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This rule would finalize proposed amendments to the final rules implementing the Mental Health Parity and Addiction Equity Act (MHPAEA). The amendments clarify plans’ and issuers’ obligations under the law, promote compliance with MHPAEA, and update requirements to take into account experience with MHPAEA in the years since the rules were finalized. The rule would also finalize new regulations implementing amendments to MHPAEA recently enacted as part of the Consolidated Appropriations Act, 2021 (CAA, 2021).

Statement of Need:

There have been a number of legislative enactments related to MHPAEA since issuance of the 2014 final rules, including the 21st Century Cures Act, the Support Act, and the CAA, 2021. This rule would propose amendments to the final rules and incorporate examples and modifications to account for this legislation and previously issued guidance and to take into account experience with MHPAEA in the years since the rules were finalized. This rule would also include new regulations implementing the nonquantitative treatment limitation (NQTL) comparative analyses requirements set forth under the CAA, 2021.

Summary of the Legal Basis:

The Department of Labor regulations would be adopted pursuant to the authority contained in 29 U.S.C. 1002, 1135, 1182, 1185d, 1191a, 1191b, and 1191c; Secretary of Labor's Order 1-2011, 77 FR 1088 (Jan. 9, 2012).

Alternatives:

The Departments considered various approaches related to NQTLs as well as comparative analysis requirements. These alternatives included not expressly incorporating the statutory requirements that NQTLs be no more restrictive for MH/SUD than M/S and requiring plans to include specific data elements in their comparative analysis These alternatives will be included in the published final rule.

Anticipated Costs and Benefits:

The Departments anticipate that the MHPAEA final rules would improve the quality of the comparative analyses conducted by plans and issuers, as required by the CAA, 2021, help plans and issuers better understand and fulfill their obligations under MHPAEA, and promote greater transparency regarding discrepancies between mental health and substance use disorder benefits and medical/surgical benefits. The Departments believe that the amendments could cause plans and issuers to revise their policies and remove limitations on treatments for mental health and substance use disorders. This will provide improved access for participants and beneficiaries seeking MH/SUD treatments which will result in better health outcomes. These expanded protections and clarifications will greatly benefit plans, participants and beneficiaries and more than justify the costs. The costs of the proposed rule include costs to the plans and issuers associated with expanded coverage and utilization, collecting, analyzing and documenting data under the revised NQTL comparative analyses requirements.

Risks:

Risks and areas of uncertainty regarding potential impacts will be included in the final rule.