Mental health parity final regulations issued

The departments of Labor, Health and Human Services, and the Treasury have issued final regulations implementing the Mental Health Parity and Addiction Equity Act (MHPAEA). The final regulations amend certain provisions of the existing MHPAEA regulations. They include time frames for health plans and issuers to respond to government requests for nonquantitative treatment limitation (NQTL) comparative analyses required under MHPAEA as well as add new content requirements. The rules emphasize the need to carefully design and manage provider networks to strengthen patient access to mental health (MH) and substance use disorder (SUD) care.

The following documents provide additional information on the final regulations:

• Employee Benefits Security Administration Fact Sheet
• New Mental Health and Substance Use Disorder Parity Rules: What They Mean for Participants and Beneficiaries
• New Mental Health and Substance Use Disorder Parity Rules: What They Mean for Providers
• New Mental Health and Substance Use Disorder Parity Rules: What They Mean for Plans and Issuers
• News Release
• White House Fact Sheet

Generally, the new final regulations reinforce that (1) MH/SUD benefits must be as easy to access as medical/surgical (M/S) benefits and (2) NQTLs applied to MH/SUD benefits (such as prior authorization requirements and methodologies to determine out-of-network reimbursement rates) cannot be more restrictive than those applied to M/S benefits.

Among other requirements, the final regulations:

• Require health plans to define whether a condition or disorder is an MH/SUD in a manner that is consistent with the most current version of the International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders.
• Require health plans to offer meaningful benefits (including a core treatment) for each covered MH/SUD in every classification in which M/S benefits (a core treatment) are offered. Plans are required to make changes when they are providing inadequate access to MH/SUD care.
• Prohibit plans from using factors and evidentiary standards to design NQTLs that discriminate against MH/SUD diagnoses.
• Require health plans to collect and evaluate data and take reasonable action, as necessary, to address material differences in access to MH/SUD benefits as compared with M/S benefits that result from application of NQTLs, where the relevant data suggest that the NQTL contributes to material differences in access.
• Codify the requirement in MHPAEA, as amended by the Consolidated Appropriations Act, 2021, that health plans conduct comparative analyses to measure the impact of NQTLs. This includes evaluating standards related to network composition, out-of-network reimbursement rates, and medical management and prior authorization NQTLs. Plans must include specific elements in documented comparative analyses and make them available to the departments, an applicable state authority and individuals upon request.
• Require comparative analyses for plans subject to ERISA to include a certification that they have engaged in a prudent process and monitored their service providers.
• Eliminate state and local government health plans’ ability to opt out of compliance with MHPAEA.

Going forward

The new final regulations are generally effective the first day of the first plan year beginning on or after January 1, 2025 (e.g., January 1, 2025, for calendar-year plans). However, certain requirements that may take more time to implement apply on the first day of the first plan year beginning on or after January 1, 2026. These include 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.

Self-funded plans should ensure they complete a NQTL comparative analysis to share upon request with the departments or a plan participant.