On Sept. 9, 2024, the Departments of Labor, Health and Human Services, and the Treasury (Departments) released a final rule to strengthen the requirements of the Mental Health Parity and Addiction Equity Act (MHPAEA). The final rule is designed to ensure that individuals do not face greater restrictions to obtaining mental health and substance use disorder (MH/SUD) benefits than they would face for medical/surgical benefits.
The final rule adds protections against more restrictive nonquantitative treatment limitations (NQTLs), such as preauthorization requirements and network composition standards. For example, the final rule requires group health plans and health insurance issuers to collect and evaluate data related to the NQTLs they place on MH/SUD care and make changes if the data shows they are providing insufficient access.
The final rule also establishes minimum standards for developing comparative analyses to assess whether NQTLs comply with MHPAEA’s requirements. In most cases, employers rely on issuers and third-party vendors to prepare comparative analyses for their health plans. However, the final rule requires the comparative analyses for health plans covered by ERISA to include a fiduciary’s certification that they have engaged in a prudent process and monitored their service providers.
The final rule generally applies for plan years beginning on or after Jan. 1, 2025; however, certain key requirements, such as NQTL data requirements, apply for plan years beginning on or after Jan. 1, 2026.
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