The United States Departments of Labor, Health and Human Services and the Treasury issued a set of final rules Sept. 9 on the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.
The rulings aim to promote equitable access to mental health and Substance Use Disorder (SUD) benefits and reduce barriers to accessing these services. They also reinforce the requirement that mental health and SUD benefits be on par with medical and surgical benefits (M/S).
If a health plan provides benefits for a mental health condition or SUD, it must provide meaningful benefits for that condition or disorder in every classification for which meaningful M/S benefits are offered. The rulings also restrict self-funded, non-federal governmental plans from opting out of providing mental health/SUD benefits. Additionally, it provides concrete factors used to determine out-of-network reimbursement rates.
The final rules also provide protection from non-quantitative treatment limitations (NQTLs) on mental health and substance use disorder benefits. NQTLs are conditions that restrict the scope of benefits, such as prior authorization requirements. The rulings prohibit insurance plans from using biased information when applying NQTLs. Issuers must also collect and assess data on the NQTLs they place and adapt accordingly if the data shows they are negatively impacting access to MH/SUD services compared to M/S benefits.
The final rules apply to:
- Group health insurance coverage beginning on or after Jan. 1, 2025. The meaningful benefits standard, the prohibition on discriminatory factors and evidentiary standards, the relevant data evaluation requirements and the related requirements in the provisions for comparative analyses will apply beginning on or after Jan. 1, 2026.
- Health insurance issuers offering individual health insurance coverage for policy years beginning on or after Jan. 1, 2026.
Members with questions may contact Lauren LaPine at the MHA.
