Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008
Revision of a currently approved collection
No
Regular
09/19/2023
Requested
Previously Approved
36 Months From Approved
10/31/2025
1,323,153
1,413,420
941,555
31,574
329,579
4,235,310
Section 9812 of the Code requires group health plans maintained by an employer with more than 50 employees to disclose upon request to participants and beneficiaries of the plan the medical necessity criteria used in making decisions regarding claims for benefits under the plan.
PL:
Pub.L. 110 - 343 511 and 512
Name of Law: Paul Wellstone and Pete Domenici Mental Health Parity and Addicition Equity Act of 2008
US Code:
26 USC 9812
Name of Law: Parity in the application of certain limits to mental health benefits
The Departments are proposing amendments to regulations implementing MHPAEA and proposes new regulations for the comparative analyses required under MHPAEA, as amended by the CAA, 2021. Specifically, this rule would amend existing and add new definitions, amend the existing NQTL standard to prevent plans and issuers from using NQTLs to place greater limits on access to MH/SUD benefits as compared to medical/surgical benefits, and add additional examples on the application of NQTLs to clarify and safeguard the protections of MHPAEA. Additionally, these proposed rules would set forth the content requirements for the comparative analyses and specify how plans and issuers must make these comparative analyses available to the Departments, any applicable State authority, and to participants, beneficiaries, and enrollees.
In addition, the data inputs, mailing costs, and wage rates have been updated. As a result, the number of responses has decreased by 90,267, the hour burden has decreased by 909,981 hours, and the cost burden has decreased by $-3,905,731.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
SS_1545-2165_2023lvd-pt2.docx
Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008