September 30, 2024
Rules Amend Certain Provisions of the Existing MHPAEA Regulations and Add new Regulations to Set Forth Content Requirements and Timeframes
On September 9, 2024, the U.S. Departments of Health and Human Services (HHS), Labor, and the Treasury released new final rules under the Mental Health Parity and Addiction Equity Act (MHPAEA), furthering its goal to eliminate disparities between mental health/substance use disorder (MH/SUD) and medical/surgical (M/S) benefits in health plans. These rules focus on ensuring that individuals seeking MH/SUD treatment do not face more restrictive limitations compared to those seeking M/S treatments.
Key provisions include:
- Strengthening Protections: Plans cannot impose nonquantitative treatment limitations (NQTLs)—such as prior authorization or network restrictions—that are more restrictive on MH/SUD benefits than M/S benefits.
- Data Evaluation and Reasonable Action: Health plans must collect and evaluate data on NQTLs and take action to address material differences in access to MH/SUD versus M/S benefits if found.
- Prohibition of Discriminatory Practices: Plans are prohibited from using discriminatory standards designed to limit MH/SUD care access.
- Comparative Analysis Requirements: Plans must conduct detailed comparative analyses of NQTLs, assessing the design and application of these limitations and ensuring they are no more restrictive for MH/SUD benefits. This analysis must be available to regulators, participants, and beneficiaries upon request.
- Network Improvements: The rules aim to improve MH/SUD provider networks, reduce red tape, and make it easier for individuals to access mental health and addiction services.
- Sunset of Opt-Out Provisions: The ability for non-Federal government plans to opt out of MHPAEA requirements is being phased out.
- Compliance Deadlines: Key provisions such as the meaningful benefits standard and data evaluation requirements apply starting January 1, 2026.
These rules, influenced by public comments, are designed to enhance the enforcement of MHPAEA and improve access to MH/SUD services by addressing ongoing disparities in health coverage.
