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Employee Benefits Security Administration

Fact Sheet

Mental Health Parity and Addiction Equity Act

EBSA plans to enhance health benefit security by publishing regulatory guidance regarding new consumer protections under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), supporting the Secretary's good jobs for everyone policy.

Key Action: Interim Final Regulation

The Department's EBSA plans to publish an interim final regulation no later than April 2010. This regulation will provide clarifications to participants, beneficiaries, health care providers, employment-based health plans, health insurance issuers, third-party administrators, and other plan service providers regarding key provisions of the statute.

Key Concerns and Issues to be Addressed

In response to a request for information (RFI) published in April 2008, over 400 comment letters were received raising questions regarding compliance with the MHPAEA parity provisions. The Department, in conjunction with the Departments of the Treasury and Health and Human Services, anticipates publishing joint interim final regulations by April 2010 to provide regulatory guidance and clarifications regarding these provisions.

Background

MHPAEA amends ERISA, the Public Health Service Act, and the Internal Revenue Code to expand the provisions under the Mental Health Parity Act of 1996 (MHPA 1996). For plans providing both medical/surgical and mental health or substance use disorder benefits, the law requires parity between medical/surgical benefits and mental health or substance use disorder benefits in the application of:

  • Aggregate lifetime and annual dollar limits,
  • Financial requirements (such as deductibles and copayments), and
  • Treatment limitations (such as limits on the number of visits or days of coverage).

Additionally, in the case of a plan that provides both medical and surgical benefits and mental health or substance use disorder benefits, if the plan provides coverage for medical or surgical benefits provided by out-of-network providers, the plan must provide coverage for mental health or substance use disorder benefits provided by out-of-network providers in a manner that is consistent with the parity requirements.

MHPAEA also requires that the criteria for medical necessity determinations made under the plan with respect to mental health or substance use disorder benefits be made available to any current or potential participant, beneficiary, or contracting provider upon request. Similarly, the reason for any denial under the plan with respect to mental health or substance use disorder benefits must be made available to any current or potential participant or beneficiary upon request.