Proposed Mental Health Parity Rule Includes Network Adequacy Requirements

The new DOL proposed rule on mental health parity is designed to ensure that participants in employer health plans do not face greater restrictions accessing and obtaining their mental health and substance use disorder benefits compared to their medical/surgical benefits.

Background: As part of the Mental Health Parity and Addiction Equity Act (MHPAEA), employers are required to perform and document a complex comparative analysis of the design and application of their non-quantitative treatment limitations (NQTLs) to demonstrate parity between mental health/substance use disorder (MH/SUD) benefits and medical/surgical benefits. Employers are also required to provide those analyses to DOL upon request. 

The proposed rule:

• Clarifies that MHPAEA requires employers to ensure plan participants can access their MH/SUD benefits in parity with their medical/surgical benefits;
  
  
• Requires employer health plans to collect and evaluate outcome data and take action to address material differences in accessing mental health benefits, with a specific focus on the application of any network composition standards; and
  
  
• Increases the standards related to network composition and network adequacy metrics, provider reimbursement rates, and prior authorization as part of new guidance on the content requirements of the nonquantitative treatment limitation (NQTL) comparative analyses.

Potential enforcement safe harbor for employers? A separate Technical Release from DOL requests comments regarding future rulemaking on the data requirements related to network composition. DOL also seeks comment on a potential enforcement safe harbor for employers regarding what data in their comparative analyses would demonstrate they meet or exceed all the standards with respect to NQTLs related to network composition, for a specified period of time.

HR Policy will be submitting comments, which are due 60 days after the rule is published in the Federal Register. The Association will also provide additional information to our members after we have fully reviewed and assessed the proposal and technical release.