On September 9, the U.S. Departments of Labor, Health and Human Services, and the Treasury released a set of final regulations regarding the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
The ruling aims to promote equitable access to mental health and substance use disorder (SUD) benefits and reduce barriers to accessing these services, and it strengthens the requirement that mental health and SUD benefits must be comparable to medical and surgical benefits (M/S).
If a health plan offers benefits for a mental illness or SUD, it must offer meaningful benefits for that illness or disability in all classifications for which meaningful M/S benefits are offered. The ruling also restricts self-funded non-federal plans from opting out of offering mental illness/SUD benefits. It also outlines the specific factors that will be used to determine out-of-network reimbursement rates.
The final rule also provides protections from nonquantitative treatment limitations (NQTLs) for mental health and substance use disorder benefits, which are conditions that limit the scope of benefits, such as prior authorization requirements. The rule prohibits insurance plans from using biased information when applying NQTLs. Issuers must collect and evaluate data on NQTLs and adjust accordingly if the data indicates that they adversely affect access to MH/SUD services compared to M/S benefits.
The final rule applies to:
Group health plans beginning on or after January 1, 2025. The relevant requirements of the meaningful benefit standards, the prohibition on discriminatory elements and evidentiary standards, related data evaluation requirements, and comparative analysis provisions apply on or after January 1, 2026. Health insurance issuers offering individual health insurance for policy years beginning on or after January 1, 2026.
Members with questions should contact Lauren LaPine, MHA.
