This week, the Federal Departments of Treasury, Labor, and Health and Human Services released final rules strengthening consumer protections for patients seeking mental health and substance use disorder treatments. Despite 15 years since the enactment of the Mental Health Parity and Addiction Equity Act (MHPAEA), barriers still exist, preventing individuals from receiving adequate coverage for these issues.
To start, the Departments reinforced existing protections, reminding health plans that they are prohibited from placing greater restrictions on access to mental health and substance use disorder benefits as compared to medical and surgical benefits. These restrictions, also referred to as nonquantitative treatment limitations (NQTL), include practices related to prior authorization requirements, network composition, and out-of-network reimbursement. Plans must now evaluate these NQTLs both on the front-end and the back-end of implementation: they cannot implement standards that systematically disfavor access to mental health and substance use disorder benefits, and they must continually collect and evaluate NQTL-related data and take reasonable actions to address material differences in how existing NQTLs impact coverage for mental health and substance abuse disorders coverage as compared to coverage for medical and surgical benefits.
Though these updates primarily focus on the actions payors need to take to achieve mental health coverage parity, it remains to be seen to what extent they will impact providers and patients.
Should you have any questions regarding the above, please contact the authors, the Garfunkel Wild attorney with whom you regularly work, or contact us at [email protected].