Reg-120692-09

REG-120692-09.pdf

Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008

REG-120692-09

OMB: 1545-2165

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5452

Federal Register / Vol. 75, No. 21 / Tuesday, February 2, 2010 / Proposed Rules

DEPARTMENT OF THE TREASURY
Internal Revenue Service
26 CFR Part 54
[REG–120692–09]
RIN 1545–BI70

Regulations Under the Paul Wellstone
and Pete Domenici Mental Health
Parity and Addiction Equity Act of 2008

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AGENCY: Internal Revenue Service (IRS),
Treasury.
ACTION: Notice of proposed rulemaking
by cross-reference to temporary
regulations and withdrawal of notice of
proposed rulemaking.
SUMMARY: Elsewhere in this issue of the
Federal Register, the IRS is issuing
temporary regulations under the Paul
Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act
of 2008 (MHPAEA). MHPAEA prohibits
group health plans providing mental
health or substance use disorder
benefits along with medical/surgical
benefits from imposing more restrictive
financial requirements or treatment
limitations with respect to the mental
health or substance use disorder
benefits than the predominant ones
imposed with respect to substantially all
medical/surgical benefits. The IRS is
issuing the temporary regulations at the
same time that the Employee Benefits
Security Administration of the U.S.
Department of Labor and the Centers for
Medicare & Medicaid Services of the
U.S. Department of Health and Human
Services are issuing substantially
similar interim final regulations with
respect to MHPAEA for group health
plans and issuers of health insurance
coverage offered in connection with a
group health plan under the Employee
Retirement Income Security Act of 1974
and the Public Health Service Act. The
temporary regulations provide guidance
to employers and group health plans
relating to the group health plan mental
health and substance use disorder parity
requirements. The text of those
temporary regulations also serves as the
text of these proposed regulations. This
document also withdraws the notice of
proposed rulemaking relating to mental
health parity requirements for group
health plans that was published on
December 22, 1997 (REG–109704–97, 62
FR 66967).
DATES: Written or electronic comments
and requests for a public hearing must
be received by May 3, 2010.
ADDRESSES: Send submissions to:
CC:PA:LPD:PR (REG–120692–09), room
5205, Internal Revenue Service, P.O.

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Box 7604, Ben Franklin Station,
Washington, DC 20044. Submissions
may be hand-delivered to:
CC:PA:LPD:PR (REG–120692–09),
Courier’s Desk, Internal Revenue
Service, 1111 Constitution Avenue,
NW., Washington, DC 20224.
Alternatively, taxpayers may submit
comments electronically via the Federal
eRulemaking Portal at http://
www.regulations.gov (IRS REG–120692–
09).
FOR FURTHER INFORMATION CONTACT:
Concerning the regulations, Russ
Weinheimer at 202–622–6080;
concerning submissions of comments,
Richard.A.Hurst@irscounsel.treas.gov,
202–622–7180 (not toll-free numbers).
SUPPLEMENTARY INFORMATION:
Paperwork Reduction Act
The collections of information
contained in this notice of proposed
rulemaking have been submitted to the
Office of Management and Budget for
review in accordance with the
Paperwork Reduction Act of 1995 (44
U.S.C. 3507(d)). Comments on the
collections of information should be
sent to the Office of Management and
Budget, Attn: Desk Officer for the
Department of the Treasury, Office of
Information and Regulatory Affairs,
Washington, DC 20503, with copies to
the Internal Revenue Service, Attn: IRS
Reports Clearance Officer,
SE:W:CAR:MP:T:T:SP, Washington, DC
20224. Comments on the collections of
information should be received by April
5, 2010. Comments are specifically
requested concerning:
• Whether the proposed collections of
information are necessary for the proper
performance of the functions of the
Internal Revenue Service, including
whether the information will have
practical utility;
• The accuracy of the estimated
burdens associated with the proposed
collections of information (see the
preamble to the temporary regulations
published elsewhere in this issue of the
Federal Register);
• How to enhance the quality, utility,
and clarity of the information to be
collected;
• How to minimize the burden of
complying with the proposed
collections of information, including the
application of automated collection
techniques or other forms of information
technology; and
• Estimates of capital or start-up costs
and costs of operation, maintenance,
and purchase of services to provide
information.
The collections of information are in
§ 54.9812–1 (see the temporary

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regulations published elsewhere in this
issue of the Federal Register). MHPAEA
includes two new disclosure provisions.
First, the criteria for medical necessity
determinations made under a group
health plan with respect to mental
health or substance use disorder
benefits must be made available in
accordance with regulations by the plan
administrator to any current or potential
participant, beneficiary, or contracting
provider upon request. MHPAEA also
requires the reason for any denial under
a group health plan of reimbursement or
payment for services with respect to
mental health or substance use disorder
benefits in the case of any participant or
beneficiary must be made available
upon request or as otherwise required
by the plan administrator to the
participant or beneficiary in accordance
with regulations. The likely respondents
are business or other for-profit
institutions, and nonprofit institutions.
Responses to these collections of
information are mandatory.
An agency may not conduct or
sponsor, and a person is not required to
respond to, a collection of information
unless it displays a valid control
number assigned by the Office of
Management and Budget.
Books or records relating to a
collection of information must be
retained as long as their contents may
become material in the administration
of any internal revenue law. Generally
tax returns and tax return information
are confidential, as required by 26
U.S.C. 6103.
Background
The temporary regulations published
elsewhere in this issue of the Federal
Register revise § 54.9812–1T to the
Miscellaneous Excise Tax Regulations.
The proposed and temporary
regulations are being published as part
of a joint rulemaking with the
Department of Labor and the
Department of Health and Human
Services (the joint rulemaking). The text
of those temporary regulations also
serves as the text of these proposed
regulations. The preamble to the
temporary regulations explains the
temporary regulations.
Special Analyses
It has been determined that this notice
of proposed rulemaking is not a
significant regulatory action as defined
in Executive Order 12866. Therefore, a
regulatory assessment is not required. It
has also been determined that section
553(b) of the Administrative Procedure
Act (5 U.S.C. chapter 5) does not apply
to this proposed regulation. It is hereby
certified that the collections of

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Federal Register / Vol. 75, No. 21 / Tuesday, February 2, 2010 / Proposed Rules

srobinson on DSKHWCL6B1PROD with PROPOSALS2

information contained in this notice of
proposed rulemaking will not have a
significant impact on a substantial
number of small entities. Accordingly, a
regulatory flexibility analysis is not
required.
The proposed rule generally applies
to employers who provide health
coverage through group health plans to
employees that include benefits for
mental health or substance use disorder
conditions. The IRS expects that the
rules to reduce the compliance burden
imposed on plans and issurers by
clarifying definitions and terms
contained in the statute and providing
examples of acceptable methods to
comply with specific provisions.
MHPAEA and the regulations under it
do not apply to employers with 50 or
fewer employees. Moreover, small
employers subject to the rule that have
more than 50 employees will generally
provide any health coverage through
insurance or a third-party administrator.
The issuers of insurance or other thirdparty administrators of the health plans,
rather than the small employers, will as
a practical matter, satisfy the
requirements of the rules in order to
provide a marketable product. For this
reason, the burden imposed by the
reporting requirement of the statute and
this notice of proposed rulemaking on
small entities is expected to be near
zero. For further information and for
analyses relating to the joint
rulemaking, see the preamble to the
joint rulemaking. Pursuant to section
7805(f) of the Internal Revenue Code,
this regulation has been submitted to
the Chief Counsel for Advocacy of the

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Small Business Administration for
comment on its impact on small
business.
Comments and Requests for a Public
Hearing
Before these proposed regulations are
adopted as final regulations,
consideration will be given to any
written comments (a signed original and
eight (8) copies) or electronic comments
that are submitted timely to the IRS.
Comments are specifically requested on
the clarity of the proposed regulations
and how they may be made easier to
understand. All comments will be
available for public inspection and
copying. A public hearing may be
scheduled if requested in writing by a
person that timely submits written
comments. If a public hearing is
scheduled, notice of the date, time, and
place for the hearing will be published
in the Federal Register.

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Withdrawal of Proposed Regulations
Accordingly, under the authority of
26 U.S.C. 7805, the notice of proposed
rulemaking (REG–109704–97) that was
published in the Federal Register on
Monday, December 22, 1997 (62 FR
66967) is withdrawn.
Proposed Amendments to the
Regulations
Accordingly, 26 CFR part 54 is
proposed to be amended as follows:
PART 54—PENSION EXCISE TAXES
Paragraph 1. The authority citation
for part 54 is amended by adding an
entry in numerical order to read as
follows:
Authority: 26 U.S.C. 7805. * * *
Section 54.9812–1 also issued under 26
U.S.C. 9833. * * *

Drafting Information
The principal author of these
proposed regulations is Russ
Weinheimer, Office of the Division
Counsel/Associate Chief Counsel (Tax
Exempt and Government Entities), IRS.
The proposed regulations, as well as the
temporary regulations, have been
developed in coordination with
personnel from the U.S. Department of
Labor and the U.S. Department of
Health and Human Services.

Par. 2. Section 54.9812–1 is added to
read as follows:

List of Subjects in 26 CFR Part 54
Excise taxes, Health care, Health
insurance, Pensions, Reporting and
recordkeeping requirements.

[FR Doc. 2010–2166 Filed 1–29–10; 8:45 am]

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§ 54.9812–1 Parity in mental health and
substance use disorder benefits.

[The text of proposed § 54.9812–1 is
the same as the text of § 54.9812–1T
published elsewhere in this issue of the
Federal Register].
Steven T. Miller,
Deputy Commissioner for Services and
Enforcement.
BILLING CODE 4830–01–P

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File TitleDocument
SubjectExtracted Pages
AuthorU.S. Government Printing Office
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File Created2010-02-23

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