The FAQs include a question concerning the compliance date for the summary of benefits and coverage (SBC) requirement under the ACA. In August 2011, the Departments issued proposed regulations and related guidance addressing the SBC requirement that included an applicability date of March 23, 2012. The question notes that higher compliance costs will result if plans attempting to meet the March 23, 2012 proposed applicability date rely on the proposed guidance to begin SBC implementation, but must then revise their implementation efforts if the final guidance is different from the proposed regulations. The answer states that:

The Departments also indicate that the final regulations will include an applicability date that gives group health plans and insurers sufficient time to comply with the requirements.

The MHPAEA, which supplemented the Mental Health Parity Act of 1996, generally requires that financial requirements and treatment limitations for mental health and substance use disorder benefits cannot be more restrictive than the main financial requirements and treatment limitations applicable to medical and surgical benefits. The MHPAEA does not, however, require plans to cover mental health and substance use disorder benefits. Under the MHPAEA and implementing regulations, group health plans or insurers generally cannot impose financial or quantitative treatment limitations on mental health or substance use disorder benefits that are more restrictive than the financial and quantitative limitations that apply to at least two-thirds of medical and surgical benefits in the same category. Examples of financial and quantitative limitations include:

In addition, nonquantitative treatment limits (for example, plan methods for determining usual, customary and reasonable fees) for mental health or substance use disorder benefits must generally be comparable to and not applied more stringently than for medical or surgical benefits.

Addressing nonquantitative treatment limitations, the FAQs state that a group health plan cannot require preauthorization from the plan's utilization reviewer as to whether treatments involving mental health and substance use disorder benefits are medically necessary if it does not require preauthorization for any medical/surgical benefits. Doing so violates the MHPAEA's prohibition on separate treatment limitations applicable only to mental health or substance use disorder benefits. Another FAQ addresses a plan that requires preauthorization of medical necessity from the plan's utilization reviewer for:

In practice, however, inpatient benefits for medical/surgical conditions are routinely approved for seven days, but inpatient mental health and substance use disorder benefits are routinely given for only one day. The Departments concluded that this arrangement was impermissible because the plan was applying a stricter nonquantitative treatment limit in practice to mental health and substance use disorder benefits than to medical/surgical benefits.

According to another FAQ, it is permissible for plans to apply concurrent review to inpatient care, even if applying this standard affects a much larger percentage of mental health and substance use disorder conditions than medical/surgical conditions. The Departments concluded that although the evidentiary standard resulted in an overall difference in application, it was acceptable because the standard was not applied more stringently for mental health and substance use disorder benefits than for medical/surgical benefits.