Requirements Related to the Mental Health Parity and Addiction Equity Act

<RULE> DEPARTMENT OF THE TREASURY <SUBAGY>Internal Revenue Service</SUBAGY> <CFR>26 CFR Part 54</CFR> <DEPDOC>[TD 10006]</DEPDOC> <RIN>RIN 1545-BQ29</RIN> DEPARTMENT OF LABOR <SUBAGY>Employee Benefits Security Administration</SUBAGY> <CFR>29 CFR Part 2590</CFR> <RIN>RIN 1210-AC11</RIN> DEPARTMENT OF HEALTH AND HUMAN SERVICES <CFR>45 CFR Parts 146 and 147</CFR> <DEPDOC>[CMS-9902-F]</DEPDOC> <RIN>RIN 0938-AU93</RIN> <SUBJECT>Requirements Related to the Mental Health Parity and Addiction Equity Act</SUBJECT> <HD SOURCE="HED">AGENCY:</HD> Internal Revenue Service, Department of the Treasury; Employee Benefits Security Administration, Department of Labor; Centers for Medicare & Medicaid Services, Department of Health and Human Services. <HD SOURCE="HED">ACTION:</HD> Final rules. <SUM> <HD SOURCE="HED">SUMMARY:</HD> This document sets forth final rules amending regulations implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and adding new regulations implementing the nonquantitative treatment limitation (NQTL) comparative analyses requirements under MHPAEA, as amended by the Consolidated Appropriations Act, 2021 (CAA, 2021). Specifically, these final rules amend the existing NQTL standard to prohibit group health plans and health insurance issuers offering group or individual health insurance coverage from using NQTLs that place greater restrictions on access to mental health and substance use disorder benefits as compared to medical/surgical benefits. As part of these changes, these final rules require plans and issuers to collect and evaluate relevant data in a manner reasonably designed to assess the impact of NQTLs on relevant outcomes related to access to mental health and substance use disorder benefits and medical/surgical benefits and to take reasonable action, as necessary, to address material differences in access to mental health or substance use disorder benefits as compared to medical/surgical benefits. These final rules also amend existing examples and add new examples on the application of the rules for NQTLs to clarify and illustrate the requirements of MHPAEA. Additionally, these final rules set forth the content requirements for NQTL comparative analyses and specify how plans and issuers must make these comparative analyses available to the Department of the Treasury (Treasury), the Department of Labor (DOL), and the Department of Health and Human Services (HHS) (collectively, the Departments), as well as to an applicable State authority, and to participants, beneficiaries, and enrollees. Finally, HHS finalizes regulatory amendments to implement the sunset provision for self-funded non-Federal governmental plan elections to opt out of compliance with MHPAEA, as adopted in the Consolidated Appropriations Act, 2023 (CAA, 2023). </SUM> <EFFDATE> <HD SOURCE="HED">DATES:</HD> <E T="03">Effective date:</E> These regulations are effective on November 22, 2024. <E T="03">Applicability date:</E> See the <E T="02">SUPPLEMENTARY INFORMATION</E> section for information on the applicability dates. </EFFDATE> <FURINF> <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD> William Fischer, Internal Revenue Service, Department of the Treasury, at 202-317-5500; Beth Baum or David Sydlik, Employee Benefits Security Administration, Department of Labor, at 202-693-8335; David Mlawsky, Centers for Medicare & Medicaid Services, Department of Health and Human Services, at 410-786-6851. </FURINF> <SUPLINF> <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD> <HD SOURCE="HD1">I. Background</HD> America continues to experience a mental health and substance use disorder crisis affecting people across all demographics, with marginalized communities disproportionately impacted. <SU>1</SU> <FTREF/> The COVID-19 pandemic exacerbated the crisis, but its effects have continued post-pandemic. <SU>2</SU> <FTREF/> From August 19, 2020, to February 1, 2021, the percentage of adults exhibiting symptoms of an anxiety or a depressive disorder rose from 36.4 percent to 41.5 percent. <SU>3</SU> <FTREF/> In 2022, there were an estimated 15.4 million adults aged 18 or older in the United States with a serious mental illness and nearly one in four adults (59.3 million) living with any mental illness. <SU>4</SU> <FTREF/> <FTNT> <SU>1</SU>  Kaiser Family Foundation (2022), Five key findings on mental health and substance use disorders by race/ethnicity, <E T="03">https://www.kff.org/mental-health/issue-brief/five-key-findings-on-mental-health-and-substance-use-disorders-by-race-ethnicity/.</E> </FTNT> <FTNT> <SU>2</SU>  American Psychological Association (2023), Stress in America <E T="51">TM</E> 2023: A nation grappling with psychological impacts of collective trauma, <E T="03">https://www.apa.org/news/press/releases/2023/11/psychological-impacts-collective-trauma.</E> </FTNT> <FTNT> <SU>3</SU>  Vahratian, A., Blumberg, S.J., Terlizzi, E.P., Schiller, J.S. (2021), Symptoms of Anxiety or Depressive Disorder and Use of Mental Health Care Among Adults During the COVID-19 Pandemic—United States, Aug. 2020-Feb. 2021, MMWR Morb Mortal Wkly Rep 2021;70:490-494, <E T="03">https://www.cdc.gov/mmwr/volumes/70/wr/mm7013e2.htm.</E> </FTNT> <FTNT> <SU>4</SU>  SAMHSA (2023), Key substance use and mental health indicators in the United States: Results from the 2022 National Survey on Drug Use and Health (HHS Publication No. PEP23-07-01-006, NSDUH Series H-58), <E T="03">https://www.samhsa.gov/data/report/2022-nsduh-annual-national-report.</E> </FTNT> Additionally, in 2022, nearly 54.6 million people aged 12 or older were classified as needing treatment for substance use, but only about 24 percent of those people received any treatment, according to the Substance Abuse and Mental Health Services Administration's (SAMHSA) National Survey on Drug Use and Health (NSDUH). <SU>5</SU> <FTREF/> The unmet need for treatment for substance use disorders has been even greater among racial minorities and other marginalized communities. Between 2019 and 2021, median monthly overdose deaths among persons aged 10-19 years increased 109 percent; and deaths involving illicitly manufactured fentanyl increased 182 percent. <SU>6</SU> <FTREF/> In 2021, American Indian and Alaskan Native men aged 15-34 had an age-adjusted death rate caused by drug overdoses of 42 per 100,000 people, compared to 20.5 age-adjusted deaths per 100,000 people during the same time period in 2018. <SU>7</SU> <FTREF/> Non-Hispanic Black or African American men aged 35-64 had an age-adjusted death rate caused by drug overdoses of 61.2 per 100,000 people; an increase from 30.6 deaths per 100,000 people during the same time period in 2018. <SU>8</SU> <FTREF/> <FTNT> <SU>5</SU>   <E T="03">Ibid.</E> </FTNT> <FTNT> <SU>6</SU>  Tanz, L.J., Dinwiddie, A.T., Mattson, C.L., O'Donnell, J., Davis, N.L. (2022), Drug Overdose Deaths Among Persons Aged 10-19 Years—United States, July 2019-Dec. 2021. MMWR Morb Mortal Wkly Rep 2022;71:1576-1582, <E T="03">https://www.cdc.gov/mmwr/volumes/71/wr/mm7150a2.htm.</E> </FTNT> <FTNT> <SU>7</SU>  Han, B., Einstein, E.B., Jones, C.M., Cotto, J., Compton, W.M., Volkow, N.D. (2022), Racial and Ethnic Disparities in Drug Overdose Deaths in the US During the COVID-19 Pandemic, JAMA Netw Open, 5(9):e2232314, DOI:10.1001/jamanetworkopen.2022.32314, <E T="03">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9490498/.</E> Age-adjusted death rates are death rates that control for the effects of differences in population age distributions. </FTNT> <FTNT> <SU>8</SU>   <E T="03">Ibid.</E> </FTNT> Following the COVID-19 pandemic, employers highlighted that they have responded to the impact of the pandemic on the mental health and substance use disorder crisis by offering more comprehensive benefits, including mental health support. According to a report published in 2021, “about three in four large employers and two in four small/medium employers report that they offer at least one type of mental health support for employees.”  <SU>9</SU> <FTREF/> In a recent survey, 87 percent of large employers stated that access to mental health care was a top priority, and another survey found that “the number of in-network behavioral health providers has increased by an average of 48 percent in 3 years among commercial health plans.”  <SU>10</SU> <FTREF/> Group health plans and health insurance issuers have taken steps to ensure mental health parity is reflected in their benefit designs and to educate participants, beneficiaries, and enrollees  <SU>11</SU> <FTREF/> about MHPAEA's requirements, by reaching out to members, expanding telehealth availability, expanding behavioral health provider networks, integrating behavioral health with physical health care, and working to reduce stigmatization of seeking treatment. <FTNT> <SU>9</SU>  Coe, E., Cordina, J., Enomoto, K., Mandel, A., Stueland, J. (2021), National Surveys Reveal Disconnect Between Employees and Employers Around Mental Health Need, McKinsey & Company, <E T="03">https://www.mckinsey.com/industries/healthcare/our-insights/national-surveys-reveal-disconnect-between-employees-and-employers-around-mental-health-need.</E> </FTNT> <FTNT> <SU>10</SU>  America's Health Insurance Plans (AHIP), Health Insurance Providers Facilitate Broad Access to Mental Health Support (Aug. 2022), <E T="03">https://ahiporg-production.s3.amazonaws.com/documents/Mental-Health-Survey-July-2022-FINAL.pdf.</E> </FTNT> <FTNT> <SU>11</SU>  Consistent with the proposed rules, these final rules apply directly to group health plans or health insurance coverage offered by an issuer in connection with a group health plan, and apply to individual health insurance coverage by cross-reference through 45 CFR 14 ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Preview showing 10k of 1343k characters. 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