Fact Sheet 

U.S. Department of Labor 

Employee Benefits Security Administration 

January 29, 2010 

The Mental Health Parity and Addiction Equity Act of 

2008 (MHPAEA) 

MHPAEA, which amended the Public Health Service Act, the Employee Retirement Income Security Act (ERISA) 

and the Internal Revenue Code, generally is effective for plan years beginning on or after October 3, 2009. For 

calendar year plans, the effective date is January 1, 2010. The Departments of Labor (DOL), Health and Human 

Services (HHS), and the Treasury will publish in the Federal Register an interim final rule implementing the 

provisions of MHPAEA on February 2, 2010. The regulation is effective on April 5, 2010, and applicable to plan 

years beginning on or after July 1, 2010. 

Background 

• The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires 

group health plans and health insurance issuers to ensure that financial requirements 

(such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable 

to mental health or substance use disorder (MH/SUD) benefits are no more restrictive 

than the predominant requirements or limitations applied to substantially all 

medical/surgical benefits. 

• MHPAEA applies to plans sponsored by private and public sector employers with more 

than 50 employees, including self-insured as well as fully insured arrangements. 

MHPAEA also applies to health insurance issuers who sell coverage to employers with 

more than 50 employees. 

• The DOL and the IRS generally have enforcement authority over private sector 

employment-based plans that are subject to ERISA. HHS has direct enforcement 

authority with respect to self-funded non-Federal governmental plans. While State 

insurance commissioners have primary authority over issuers in the large group market, 

HHS has secondary enforcement authority. 

• MHPAEA supplements prior provisions under the Mental Health Parity Act of 1996 

(MHPA), which required parity with respect to aggregate lifetime and annual dollar 

limits for mental health benefits. DOL, HHS and Treasury issued regulations under 

MHPA in 1997. The MHPAEA interim final rule amends and modifies certain 

provisions in the MHPA regulations. 

• Although MHPAEA provides significant new protections to participants in group 

health plans, it is important to note that MHPAEA does not mandate that a plan provide 

MH/SUD benefits. Rather, if a plan provides medical/surgical and MH/SUD benefits, 

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it must comply with the MHPAEA’s parity provisions. Also, MHPAEA does not apply 

to issuers who sell health insurance policies to employers with 50 or fewer employees 

or who sell health insurance policies to individuals. 

MHPAEA Continues and Expands MHPA

• As noted above, MHPA required parity with respect to aggregate lifetime and annual 

dollar limits. However, MHPA did not apply to substance use disorder benefits. 

MHPAEA continued the MHPA parity rules as to limits for mental health benefits, and 

amended them to extend to substance use disorder benefits. 

• Therefore, plans and issuers that offer substance use disorder benefits subject to 

aggregate lifetime and annual dollar limits must comply with the MHPAEA’s parity 

provisions. 

• The regulations demonstrate how the expanded rules apply, and update certain defined 

terms and examples as necessary. 

Additional MHPAEA Protections Relating to Financial Requirements

• Under MHPAEA, if a plan or issuer that offers medical/surgical and MH/SUD benefits 

imposes “financial requirements” (such as deductibles, copayments, coinsurance and 

out of pocket limitations), the financial requirements applicable to MH/SUD benefits 

can be no more restrictive than the “predominant” financial requirements applied to 

“substantially all” medical/surgical benefits. 

• The regulations provide that the “predominant/substantially all” test applies to six 

classifications of benefits on a classification-by-classification basis. The regulation also 

includes other rules and definitions that are necessary in order for plans, issuers and 

their advisers to apply this general parity test. 

 

Additional MHPAEA Protections Relating to Treatment Limitations

• MHPAEA also provides similar protections for treatment limitations. “Treatment 

limitations” mean limits on the frequency of treatment, number of visits, days of 

coverage, or other similar limits on the scope or duration of treatment. 

• The regulation clarifies that there may be both quantitative and non-quantitative 

treatment limitations, and provides rules for each. Since they are similar to financial 

requirements, quantitative treatment limitations are subject to the same general test as 

the financial requirements discussed above. 

• Because non-quantitative treatment limitations (such as medical management 

standards, formulary design, and determination of usual/customary/reasonable 

amounts) apply differently, the regulation includes a separate parity requirement for 

them. 

Parity with Respect to Out of Network Benefits 

• If a plan or issuer that offers medical/surgical benefits on an out-of-network basis also 

offers MH/SUD benefits, it must offer the MH/SUD benefits on an out-of-network 

basis as well. 

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MHPAEA Availability of Plan Information Requirements 

• MHPAEA requires that plans make certain information available with respect to 

MH/SUD benefits. First, the criteria for medical necessity determinations with respect 

to MH/SUD benefits must be made available to any current or potential participant, 

beneficiary, or contracting provider upon request. 

• MHPAEA also provides that the reason for any denial of reimbursement or payment for 

services with respect to MH/SUD benefits must be made available, upon request or as 

otherwise required, to the participant or beneficiary. 

• The regulation clarifies that, for non-Federal governmental plans (which are not subject 

to ERISA), and health insurance coverage offered in connection with such plans, 

compliance with the form and manner of the ERISA claims procedure regulations for 

group health plans satisfies this disclosure requirement. 

Exemptions from MHPAEA 

• MHPAEA retains the exemption for small employers contained in MHPA. MHPAEA 

modified the exemption contained in MHPA based on increased cost in several 

respects, which are explained in the statute. 

• The MHPAEA regulation updates the small employer exemption, withdraws the 

MHPA regulations concerning the increased cost exemption, and reserves paragraph 

(g) for additional future guidance. 

 

Additional Issues 

• The MHPAEA interim final rule is intended to address the most pressing issues that affect 

the ability of plans and issuers to comply in the near term. The Departments noted several 

issues in the preamble, and specifically requested comments on: 

3⁄4 Whether additional examples would be helpful to illustrate the application of the nonquantitative treatment limitation rule to other features of medical management or 

general plan design;

3⁄4 Whether and to what extent MHPAEA addresses the “scope of services” or 

“continuum of care” provided by a group health plan or health insurance coverage;

3⁄4 What additional clarifications might be helpful to facilitate compliance with the 

disclosure requirement for medical necessity criteria or denials of MH/SUD benefits; 

and 

3⁄4 Implementing the new statutory requirements for the increased cost exemption under 

MHPAEA, as well as information on how many plans expect to use the exemption. 

 

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