In September 2024, federal agencies released a final rule to strengthen the requirements of the Mental Health Parity and Addiction Equity Act (MHPAEA). The final rule is designed to help ensure individuals do not face greater restrictions to obtaining mental health and substance use disorder (MH/SUD) benefits than they would face for medical/surgical (M/S) benefits.
Significantly, the final rule adds protections against more restrictive nonquantitative treatment limitations (NQTLs), such as network composition, out-of-network reimbursement rates and prior authorization requirements. 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 generally applies for plan years beginning on or after Jan. 1, 2025; however, certain key requirements, such as the NQTL data evaluation requirements, apply for plan years beginning on or after Jan. 1, 2026.
The final rule also establishes minimum standards for developing comparative analyses to assess whether an NQTL, as written and in operation, complies with MHPAEA’s requirements. Plans and issuers that cover both M/S benefits and MH/SUD benefits and impose NQTLs on MH/SUD benefits must perform and document a comparative analysis of the design and application of each applicable NQTL.
In many cases, issuers and third-party administrators will help prepare comparative analyses for employer-sponsored health plans. However, the final rule requires the comparative analyses for ERISA-covered plans to also include a plan fiduciary’s certification that they have engaged in a prudent process and monitored their service providers.
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