265 Enforcing Mental Health Parity 2015
forcement authority and primary means of enforcing the MHPAEA.104 In
doing so, the Obama Administration deferred to states as the regulators of
insurance.105 The regulation became effective in January 2014 and applies
to plan years beginning on or after July 1, 2014.106
The final rule includes a number of provisions detailing permissible financial requirements and treatment limitations under the MHPAEA107 and
provides additional consumer protections.108 Regarding enforcement, the
Centers for Medicare and Medicaid Services (“CMS”) stated that it believed
most states had the authority to enforce the parity law and were already acting appropriately.109 In states lacking the authority to enforce the law, CMS
stated it would either directly enforce the MHPAEA or collaborate with
state insurance departments to ensure compliance.110
C. Enforcement under the ACA
President Barack Obama signed the ACA into law on March 23, 2010.111
104. SUBSTANCE ABUSE & MENTAL HEALTH SERVICES ADMIN., supra note 99 (“State
insurance commissioners oversee individual and employer-funded plans of less than 51 insured employees, as well as fully-insured large group plans.”); id.
105. See supra Part 0 for a discussion of health insurance law with respect to federalism.
106. THE CTR. FOR CONSUMER INFO. & INS. OVERSIGHT, supra note 14.
108. See Press Release, U.S. Dep’t of Health & Servs., Administration Issues Final
Mental Health and Substance Use Disorder Parity Rule (Nov. 8, 2013),
http://www.hhs.gov/news/press/2013pres/11/20131108b.html (explaining that these additional consumer protections include ensuring parity applies to intermediate levels of care in
certain treatment settings; clarifying the scope of transparency required by health plans; clarifying the standards to which parity applies; and eliminating loopholes in the original Act).
109. Final Rules, 78 Fed. Reg. 68240, 68252 (Nov. 13, 2013) (to be codified at 45
C.F.R. pts. 146 and 147), available at http://www.gpo.gov/fdsys/pkg/FR-2013-11-
110. Id. On the DOL website, agency enforcement efforts were further detailed:
[DOL, HHS, & IRS] are working with plans, issuers, and their service providers
to help them understand and come into compliance with MHPAEA and to ensure
that individuals receive the benefits they are entitled to under the law. The Departments also coordinate with State regulators both individually and through the
National Association of Insurance Commissioners to ensure compliance and issue
guidance to address frequently asked questions from stakeholders. Compliance
assistance is a high priority and the Departments’ approach to implementation is
marked by an emphasis on assisting plans and issuers that are working diligently
and in good faith to comply with the requirements of the law.
EMP. BENEFITS SEC. ADMIN., FAQs About Affordable Care Act Implementation (Part XVII)
and Mental Health Parity Implementation, U.S. DEP’T OF LABOR (Nov. 8, 2013),
111. Patient Protection and Affordable Care Act (PPACA), Pub L. No. 111-148, 124
Stat. 119 (2010) (codified as amended in scattered sections of 42 U.S. C.).