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.
$26,913,080
No
Yes
No
No
No
No
No
Mara Blumenthal 202 693-8538
blumenthal.mara@dol.gov
No
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.