- On September 16, 2024
On September 9, 2024, the federal Departments of Health and Human Services, Labor, and Treasury released the final version of an update to the rules implementing the Mental Health Parity and Addiction Equity Act (MHPAEA). The final regulation gives specifics about how health insurance carriers and employer plan sponsors must regularly test health coverage options to make sure non-quantitative treatment limitations (NQTLs) are not applied more stringently to mental health and substance use disorders (MH/SUD) than they are to medical and surgical (M/S) treatments and conditions.
MHPAEA requirements apply to all individual and group fully insured health coverage options and to self-funded, and level-funded employer group plans with 51 or more employees. Health insurance carriers and employer plan sponsors must test their plans regularly for parity compliance by examining written requirements and operational data. When conducting NQTL comparative analyses, plans and issuers must:
- Define whether a condition or disorder is an MH/SUD using the most current version of the International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders;
- Assess if the coverage includes meaningful benefits (including a core treatment) for each covered MH/SUD condition in every classification in which M/S benefits (a core treatment) are offered;
- Not use factors and evidentiary standards to design NQTLs that discriminate against MH conditions and SUDs;
- Collect and evaluate relevant outcomes data and take reasonable action, as necessary, to address material differences in access to MH/SUD benefits as compared to M/S benefits and
- Include specific elements in documented comparative analyses, make them available to federal and state regulators, and plan participants upon request.
- Suppose the plan is subject to ERISA (and almost all employer plans are). In that case, the analysis must include a certification that the plan sponsor uses prudent processes when administering their plan and monitors their service providers.
The final rules also eliminate the ability of a state or local government health plan to opt out of compliance with MHPAEA. They include detailed examples of how to complete complaint NQTL analyses. They provide guidance and assistance to employer plan sponsors who need to obtain data to complete and maintain their analyses from plan service providers.
For employers offering fully insured coverage through an issuer or sponsoring a self-funded or level-funded group health plan, the new requirements generally take effect with the following plan year beginning on or after January 1, 2025. However, the provisions implementing the meaningful benefits standard, the prohibition on discriminatory factors and evidentiary standards, the required use of outcomes data, and certain related comparative analysis requirements apply for plan years beginning on or after January 1, 2026. For individual health insurance coverage, the final rules apply for policy years beginning on or after January 1, 2026.