[Federal Register Volume 71, Number 82 (Friday, April 28, 2006)]
[Rules and Regulations]
[Pages 25092-25093]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 06-3972]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

45 CFR Part 146

[CMS-4094-F4]
RIN 0938-AN80


Amendment to the Interim Final Regulation for Mental Health 
Parity

AGENCY: Centers for Medicare & Medicaid Services (CMS), DHHS.

ACTION: Amendment to interim final regulation.

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SUMMARY: This document amends the interim final regulation that 
implements the Mental Health Parity Act of 1996 (MHPA) to conform the 
sunset date of the regulation to the sunset date of the statute under 
legislation passed on December 30, 2005.

DATES: Effective date: The amendment to the regulation is effective May 
30, 2006.
    Applicability dates: Under the amendment, the requirements of the 
MHPA interim final regulation apply to group health plans and health 
insurance coverage offered in connection with a group health plan 
during the period commencing May 30, 2006 through December 31, 2006.

FOR FURTHER INFORMATION CONTACT: Dave Mlawsky, Centers for Medicare & 
Medicaid Services (CMS), Department of Health and Human Services, at 1-
877-267-2323, ext. 61565.

SUPPLEMENTARY INFORMATION:

I. Background

    The Mental Health Parity Act of 1996 (MHPA) was enacted on 
September 26, 1996 (Pub. L. 104-204). MHPA amended the Public Health 
Service Act (PHS Act) and the Employee Retirement Income Security Act 
of 1974 (ERISA) to provide for parity in the application of annual and 
lifetime dollar limits on mental health benefits and the application of 
dollar limits on medical/surgical benefits. Provisions implementing 
MHPA were later added to the Internal Revenue Code of 1986 (Code) under 
the Taxpayer Relief Act of 1997 (Pub. L. 105-34).
    The provisions of MHPA are set forth in Title XXVII of the PHS Act, 
Part 7 of Subtitle B of Title I of ERISA, and Chapter 100 of Subtitle K 
of the Code. The Secretaries of Health and Human Services, Labor, and 
the Treasury share jurisdiction over the MHPA provisions. These 
provisions are substantially similar, except for jurisdictional 
differences. See for example, the amendment to the interim final rule 
published July 22, 2005 (70 FR 42276).

II. Overview of MHPA

    The MHPA provisions are set forth in section 2705 of the PHS Act, 
section 712 of ERISA, and section 9812 of the Code. MHPA applies to a 
large group health plan (or health insurance coverage offered in 
connection with a large group health plan) that provides both medical/
surgical benefits and mental health benefits. MHPA's original text 
included a sunset provision specifying that MHPA's provisions would not 
apply to

[[Page 25093]]

benefits for services furnished on or after September 30, 2001. On 
December 22, 1997, the Departments of Health and Human Services, Labor, 
and the Treasury issued interim final regulations under MHPA in the 
Federal Register (62 FR 66931). The interim final regulations included 
this statutory sunset date.
    The sunset date has been extended on a yearly basis by subsequent 
statutory provisions, which are described in detail in the amendment to 
the interim final rule published July 22, 2005 (70 FR 42276). The 
Department has published changes to the interim final mental health 
parity regulations to conform the expiration date of the regulation to 
each new statutory sunset date. (See 70 FR 42276, July 22, 2005).
    On December 30, 2005, President Bush signed H.R. 4579 (Pub. L. 109-
151). That legislation further extended MHPA's sunset date under the 
PHS Act, ERISA, and the Tax Code so that MHPA's provisions apply to any 
services furnished through December 31, 2006.
    This statutory amendment has not altered MHPA's scope. It continues 
to apply to a large group health plan (or health insurance coverage 
offered in connection with a large group health plan) that provides 
both medical/surgical benefits and mental health benefits. To assist 
plan sponsors, health insurance issuers, and covered individuals, the 
Department is publishing this amendment to the interim final 
regulations, conforming the regulatory sunset date to the new statutory 
sunset date. The Department is making the effective date of this 
amendment to the interim final regulations effective as of May 30, 
2006. Since the extension of this sunset date is essentially self-
implementing, this amendment to the MHPA regulations is published on an 
interim final basis under section 2792 of the PHS Act.

III. Collection of Information Requirements

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995.

IV. Regulatory Impact Statement

Overall Impact

    We have examined the impacts of this rule as required by Executive 
Order 12866 (September 1993, Regulatory Planning and Review), the 
Regulatory Flexibility Act (RFA) (September 16, 1980, Pub. L. 96-354), 
the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4), and Executive 
Order 13132.
    Executive Order 12866 (as amended by Executive Order 13258, which 
merely reassigns responsibility of duties) directs agencies to assess 
all costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). A 
regulatory impact analysis (RIA) must be prepared for major rules with 
economically significant effects ($100 million or more in any 1 year). 
According to the terms of the Executive Order, it has been determined 
that this action is not a ``significant regulatory action'' within the 
meaning of the Executive Order. Rather, it is an amendment to the 1997 
interim final regulations that makes no substantive changes to those 
regulations, and merely extends the regulatory sunset date to conform 
to the new statutory sunset date added by Public Law 109-151. Because 
it is not a major rule, we are not required to perform an assessment of 
the costs and savings.
    The RFA requires agencies to analyze options for regulatory relief 
of small businesses. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations, and government agencies. 
Most hospitals and most other providers and suppliers are small 
entities, either by nonprofit status or by having revenues of $6 
million to $29 million in any 1 year. Individuals and States are not 
included in the definition of a small entity. We are not preparing an 
analysis for the RFA because we have determined, and we certify, that 
this rule will not have a significant economic impact on a substantial 
number of small entities.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule that may result in expenditure in any 1 year by State, 
local, or tribal governments, in the aggregate, or by the private 
sector, of $110 million. This rule will have no consequential effect on 
the governments mentioned or on the private sector.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it publishes a proposed rule (and subsequent 
final rule) that imposes substantial direct requirement costs on State 
and local governments, preempts State law, or otherwise has Federalism 
implications. We have reviewed this final rule and have determined that 
it will not have a substantial effect on State or local governments.
    We have reviewed this rule and determined that, under the 
provisions of Public Law 104-121, the Contract with America Act, it is 
not a major rule.

List of Subjects in 45 CFR Part 146

    Health care, Health insurance, Reporting and recordkeeping 
requirements, State regulation of health insurance.


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For the reasons set forth in the preamble, the Centers for Medicare & 
Medicaid Services amends 45 CFR part 146 as follows:

PART 146--REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET

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1. The authority citation for part 146 is revised to read as follows:

    Authority: Secs. 2705, 2791, and 2792 of the PHS Act (42 U.S.C. 
300gg-5, 300gg-91, and 300gg-92).


Sec.  146.136  [Amended]

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2. In Sec.  146.136, the following amendments are made:
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a. The last sentence of paragraph (f)(1) is amended by removing the 
date ``December 31, 2005'' and adding in its place the date ``December 
31, 2006.''
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b. Paragraph (g)(2) is amended by removing the date ``January 1, 2006'' 
and adding in its place the date ``January 1, 2007.''
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c. Paragraph (i) is revised to read as follows:


Sec.  146.136  Parity in the application of certain limits to mental 
health benefits.

* * * * *
    (i) Sunset. This section does not apply to benefits for services 
furnished after December 31, 2006.

    Dated: March 8, 2006.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
    Dated: April 14, 2006.
Michael O. Leavitt,
Secretary, Department of Health and Human Services.
[FR Doc. 06-3972 Filed 4-27-06; 8:45 am]
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