February 3, 2010

Alas! MHPAEA Regulations

The much anticipated regulations interpreting the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) have, at long last, been issued, as interim final regulations. The MHPAEA, enacted on October 3, 2008, expanded the Mental Health Parity law, enacted in 1996. 

Neither mental health parity laws require plans to provide coverage for mental health services.  What both laws do require is that if mental health coverage is provided in a group health plan, sponsored by an employer employing 50 or more employees, it must be treated comparably to medical and surgical services.  The MHPAEA specifically requires that mental health services, including substance use disorders, must be treated the same as medical and surgical services in all respects, including payment and treatment.

These regulations underscore that, in all respects, mental health and substance abuse disorder benefits must be comparable to medical and surgical benefits. The regulations define six categories of benefits that must be comparable, as follows:

  1. Inpatient, in-network;
  2. Inpatient, out-of-network;
  3. Outpatient, in-network;
  4. Outpatient, out-of-network;
  5. Emergency care; and
  6. Prescription drugs.

While the law is now in effect for calendar year plans, the regulations will become applicable for plan years beginning on or after July 1, 2010, which means January 1, 2011, for calendar year plans.  In the meantime, plans must make a good faith attempt to comply with the terms and conditions of the law.  In the time between now and the time the regulations take effect, plans should be reviewed to ensure they are in compliance with the more specific terms of the regulations.


The information contained in this Benefit Beat is not intended to be legal, accounting, or other professional advice, nor are these comments directed to specific situations.

As required by U.S. Treasury rules, we inform you that, unless expressly stated otherwise, any U.S. federal tax advice contained in this Benefit Beat is not intended or written to be used, and cannot be used, by any person for the purpose of avoiding any penalties that may be imposed by the Internal Revenue Service.

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