The U.S. Department of Labor, Department of Health and Human Services (HHS), and Department of the Treasury are requesting public comments on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA; Public Law 110-343) prior to further rulemaking and publication of regulations for implementation of the law. Click here for the Federal Register announcement.

Comments may be submitted until May 28, 2009 to the Department of Labor, the Department of Health and Human Services, or the Internal Revenue Service (addresses below). Comments should be submitted to only one agency; and will be shared with the other Departments.

The Departments seek comments in the following specific areas:

Comments Regarding Economic Analysis, Paperwork Reduction Act, and Regulatory Flexibility Act

• What policies, procedures, or practices of group health plans and health insurance issuers may be impacted by MHPAEA? What direct or indirect costs would result? What direct or indirect benefits would result? Which stakeholders will be impacted by such benefits and costs?
• Are there unique costs and benefits for small entities subject to MHPAEA (that is, employers with greater than 50 employees that maintain plans with fewer than 100 participants)? What special consideration, if any, is needed for these employers or plans? What costs and benefits have issuers and small employers experienced in implementing parity under State insurance laws or otherwise?
• Are there additional paperwork burdens related to MHPAEA compared with those related to MHPA 1996, and, if so, what estimated hours and costs are associated with those additional burdens?

Comments Regarding Regulatory Guidance

• The statute provides that the term ‘‘financial requirement’’ includes deductibles, copayments, coinsurance, and out-of-pocket expenses, but excludes an aggregate lifetime limit and an annual limit. The statute further provides that the term ‘‘treatment limitation’’ includes limits on the frequency of treatment, number of visits, days of coverage, or other similar limits on the scope or duration of treatment. Do plans currently impose other types of financial requirements or treatment limitations on benefits? How do plans currently apply financial requirements or treatment limitations to (1) medical and surgical benefits and (2) mental health and substance use disorder benefits? Are these requirements or limitations applied differently to both classes of benefits? Do plans currently vary coverage levels within each class of benefits?
• What terms or provisions require additional clarification to facilitate compliance? What specific clarifications would be helpful?
• What information, if any, regarding the criteria for medical necessity determinations made under the plan (or coverage) with respect to mental health or substance use disorder benefits is currently made available by the plan? To whom is this information currently made available and how is it made available? Are there industry standards or best practices with respect to this information and communication of this information?
• What information, if any, regarding the reasons for any denial under the plan (or coverage) of reimbursement or payment for services with respect to mental health or substance use disorder benefits is currently made available by the plan? To whom is this information currently made available and how is it made available? Are there industry standards or best practices with respect to this information and communication of this information?
• To gather more information on the scope of out-of-network coverage, the Departments are interested in finding out whether plans currently provide out-of-network coverage for mental health and substance use disorder benefits. If so, how is such coverage the same as or different than out-of-network coverage provided for medical and surgical benefits?
• Which aspects of the increased cost exemption, if any, require additional guidance? Would model notices be helpful to facilitate disclosure to Federal agencies, State agencies, and participants and beneficiaries regarding a plan’s or issuer’s election to implement the cost exemption?

Contact Information

Department of Labor
Office of Health Plan Standards and Compliance Assistance
Employee Benefits Security Administration
Room N-5653
or
U.S. Department of Labor
200 Constitution Avenue, NW.
Washington, DC 20210
Attention: MHPAEA Comments

E-mail: E-OHPSCA.EBSA@dol.gov
Internet: http://www.regulations.gov/

Department of Health and Human Services
7500 Security Boulevard
Baltimore, MD 21244-1850
or
Room 445-G, Hubert H. Humphrey Building
200 Independence Avenue, SW.
Washington, DC 20201.

Internet: http://www.regulations.gov/

Internal Revenue Service
CC:PA:LPD:PR (REG-120692-09)
Room 5205
Internal Revenue Service
or
P.O. Box 7604
Ben Franklin Station
Washington, DC 20044

Internet: http://www.regulations.gov/

Comments made to the Departments will be posted on the web at http://www.regulations.gov or http://www.dol.gov/ebsa. Follow search instructions on each page to view public comments.