[Federal Register Volume 88, Number 187 (Thursday, September 28, 2023)]
[Proposed Rules]
[Pages 66728-66730]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-21177]


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DEPARTMENT OF THE TREASURY

Internal Revenue Service

26 CFR Part 54

[REG-120727-21]
RIN 1545-BQ29

DEPARTMENT OF LABOR

Employee Benefits Security Administration

29 CFR Part 2590

RIN 1210-AC11

DEPARTMENT OF HEALTH AND HUMAN SERVICES

45 CFR Parts 146 and 147

[CMS-9902-P]
RIN 0938-AU93


Requirements Related to the Mental Health Parity and Addiction 
Equity Act; Extension of Comment Period

AGENCY: 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.

ACTION: Proposed rules; extension of comment period.

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SUMMARY: This document extends the comment period for the proposed 
rules entitled ``Requirements Related to the Mental Health Parity and 
Addiction Equity Act'' that were published in the August 3, 2023, issue 
of the Federal Register. The comment period for the proposed rules, 
which had been scheduled to close on October 2, 2023, is extended 15 
days to October 17, 2023.

DATES: The comment period for the proposed rules published August 3, 
2023, at 88 FR 51552, is extended. To be assured consideration, 
comments must be received at one of the addresses provided below, no 
later than October 17, 2023.

ADDRESSES: Written comments may be submitted to the addresses specified 
below. Any comment that is submitted will be shared with the Department 
of the Treasury (Treasury Department), Internal Revenue Service (IRS), 
and the Department of Health and Human Services (HHS). Please do not 
submit duplicates.
    Comments will be made available to the public. Warning: Do not 
include any personally identifiable information

[[Page 66729]]

(such as name, address, or other contact information) or confidential 
business information that you do not want publicly disclosed. All 
comments are posted on the internet exactly as received and can be 
retrieved by most internet search engines. No deletions, modifications, 
or redactions will be made to the comments received, as they are public 
records. Comments may be submitted anonymously.
    In commenting, please refer to file code 1210-AC11. Because of 
staff and resource limitations, the Department of Labor (DOL) cannot 
accept comments by facsimile (FAX) transmission.
    Comments, including mass comment submissions, must be submitted in 
one of the following two ways (please choose only one of the ways 
listed):
    1. Electronically. You may submit electronic comments on this 
regulation to https://www.regulations.gov. Follow the ``Submit a 
comment'' instructions.
    2. By mail. You may mail written comments to the following address 
ONLY: Office of Health Plan Standards and Compliance Assistance, 
Employee Benefits Security Administration, Room N-5653, U.S. Department 
of Labor, 200 Constitution Avenue NW, Washington, DC 20210, Attention: 
1210-AC11.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.

FOR FURTHER INFORMATION CONTACT: Shira McKinlay, 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.

Customer Service Information

    Individuals interested in obtaining information from DOL concerning 
private employment-based health coverage laws may call the Employee 
Benefits Security Administration (EBSA) Toll-Free Hotline at 1-866-444-
EBSA (3272) or visit the DOL's website (www.dol.gov/agencies/ebsa).
    In addition, information from HHS on private health insurance 
coverage and coverage provided by self-funded, non-Federal governmental 
group health plans can be found on the Centers for Medicare & Medicaid 
Services (CMS) website (www.cms.gov/cciio), and information on health 
care reform can be found at www.Healthcare.gov or https://www.hhs.gov/healthcare/index.html. In addition, information about mental and 
behavioral health and addiction is available at https://www.samhsa.gov/mental-health and https://www.samhsa.gov/find-support.

SUPPLEMENTARY INFORMATION: In the proposed rules, ``Requirements 
Related to the Mental Health Parity and Addiction Equity Act,'' 
released by the Departments of the Treasury, Labor, and HHS 
(collectively, the Departments) on July 25, 2023, and published in the 
Federal Register on August 3, 2023 (88 FR 51552), the Departments 
solicited public comments on proposals to amend the regulations that 
implement the Paul Wellstone and Pete Domenici Mental Health Parity and 
Addiction Equity Act of 2008 (MHPAEA) and establish new regulations for 
the nonquantitative treatment limitation (NQTL) comparative analyses 
required under MHPAEA, as amended by the Consolidated Appropriations 
Act, 2021. The proposed rules would amend the existing NQTL standard to 
prevent group health plans and health insurance issuers offering group 
or individual health insurance coverage that provides both medical and 
surgical benefits and mental health or substance use disorder benefits 
from using NQTLs to place greater limits on access to mental health and 
substance use disorder benefits as compared to medical/surgical 
benefits. As part of these proposed changes, the proposed rules would 
require plans and issuers to collect and evaluate relevant data in a 
manner reasonably designed to assess the impact of NQTLs on access to 
mental health and substance use disorder benefits and medical/surgical 
benefits, and propose a special rule for NQTLs related to network 
composition. The proposed rules also would amend existing examples and 
add new examples on the application of the rules for NQTLs to clarify 
and illustrate the protections of MHPAEA. In addition, the proposed 
rules would set forth the content requirements for NQTL comparative 
analyses and specify how plans and issuers must make these comparative 
analyses available to the Departments, as well as to an applicable 
State authority, and participants, beneficiaries, and enrollees. The 
Departments also solicited comments on whether there are ways to 
improve the coverage of mental health and substance use disorder 
benefits through other provisions of Federal law. Additionally, HHS 
proposed 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. The 
comment period for the proposed rules was scheduled to close on October 
2, 2023.
    Additionally, on July 25, 2023, DOL, in collaboration with HHS and 
the Treasury Department, issued Technical Release 2023-01P.\1\ The 
Technical Release sets out principles and seeks public comment to 
inform future guidance with respect to the application of the proposed 
data collection and evaluation requirements to NQTLs related to network 
composition and a potential time-limited enforcement safe harbor for 
plans and issuers that include data in their comparative analyses that 
demonstrates they meet or exceed all of the thresholds identified in 
future guidance with respect to NQTLs related to network composition. 
Specifically, the Technical Release solicits feedback on the type, 
form, and manner for the data that plans and issuers would be required 
to include, along with other relevant data as appropriate, as part of 
their comparative analyses for NQTLs related to network composition 
which must be submitted to the Departments upon request. The Technical 
Release also solicits feedback on how to define certain thresholds for 
required data and a potential time-limited enforcement safe harbor to 
be specified in future guidance that, if satisfied, would demonstrate 
to the Departments that a plan or coverage provides comparable access 
to in-network providers for mental health and substance use disorder 
benefits as compared to medical/surgical benefits. In turn, if all of 
these safe harbor thresholds are met or exceeded, the plan or issuer 
would not be subject to Federal enforcement under MHPAEA with respect 
to NQTLs related to network composition for a specified period of time. 
Comments on Technical Release 2023-01P should be sent via email to 
<a href="/cdn-cgi/l/email-protection#9af7f2eafbfffbb4e8fcf9b4fff8e9fbdafef5f6b4fdf5ec"><span class="__cf_email__" data-cfemail="ff92978f9e9a9ed18d999cd19a9d8c9ebf9b9093d1989089">[email protected]</span></a>. All comments on Technical Release 2023-01P 
submitted to DOL will be shared with HHS, the IRS, and the Treasury 
Department and posted on DOL's Employee Benefits Security 
Administration's (EBSA) website. The comment period for Technical 
Release 2023-01P was scheduled to close on October 2, 2023.
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    \1\ Department of Labor, Employee Benefits Security 
Administration, Technical Release 2023-01P: Request for Comment on 
Proposed Relevant Data Requirements for Nonquantitative Treatment 
Limitations (NQTLs) Related to Network Composition and Enforcement 
Safe Harbor for Group Health Plans and Health Insurance Issuers 
Subject to the Mental Health Parity and Addiction Equity Act (July 
25, 2023), available at https://www.dol.gov/agencies/ebsa/employers-and-advisers/guidance/technical-releases/23-01.
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    Since the publication of the proposed rules in the Federal Register 
and the release of Technical Release 2023-01P on EBSA's website, there 
has been considerable interest expressed in these

[[Page 66730]]

documents, and some interested parties have requested additional time 
to review and submit comments. The Departments value public feedback as 
they consider whether and how to issue final rules and future guidance. 
In response to these requests, the Departments are extending the period 
for submitting comments on the proposed rules to October 17, 2023. 
Additionally, to ensure consistency with the comment period for the 
proposed rules, DOL is simultaneously extending the comment period for 
Technical Release 2023-01P to October 17, 2023. To be assured 
consideration, comments on the proposed rules and Technical Release 
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must be received no later than October 17, 2023.

    Dated: September 22, 2023.
Douglas W. O'Donnell,
Deputy Commissioner for Services and Enforcement, Internal Revenue 
Service.

Lisa M. Gomez,
Assistant Secretary, Employee Benefits, Security Administration, 
Department of Labor.

Xavier Becerra,
Secretary, Department of Health and Human Services.
[FR Doc. 2023-21177 Filed 9-27-23; 8:45 am]
BILLING CODE P


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