By April Handlir, Compliance Manager, EHD
Let’s talk about the Mental Health Parity and Addiction Equity Act (MHPAEA) — yes, it’s still the law, and yes, it’s still a bit of a compliance Rubik’s Cube. But don’t fret, EHD is here to guide you through the twists and turns providing clarity, compliance, and maybe even a sigh of relief for employers with a fully insured or self-funded group health plan of 50 or more employees.
The MHPAEA Is Still in Effect
Despite the legal drama and regulatory pauses,MHPAEA remains the least appetizing on the law menu. That means:
- Quantitative Treatment Limits (QTLs) like copays, deductibles, coinsurance, out-of-pocket maximums (OOPM) and visit limits (days and frequency) must be no more restrictive for mental health/substance use disorder (MH/SUD) than for medical/surgical (M/S) benefits.
- Non-Quantitative Treatment Limits (NQTLs) — think prior authorizations, step therapy, admission standards and reimbursement standards—must also be equivalent.
Let us take a quick journey down memory lane….
2013: The delivery of the six classifications of benefits
This statute said plans cannot “impose a greater burden on access” for MH/SUD than M/S when under the same benefit classification. These guidelines were for financial requirements, QTLs and NQTLs. This was a piece of cake for employers since the requirements are easily identifiable with measurable outcomes.
The categories introduced:
- Inpatient in-network
- Inpatient out-of-network
- Outpatient in-network
- Outpatient out-of-network
- Emergency care
- Prescription Drugs
2021: The Year of the (Non)Compliant Analysis
In 2021, The Consolidate Appropriations Act (CAA) required plans to complete a comparative analysis of the NQTLs that would be available in case of an audit. The Departments came knocking, and what they found was… underwhelming. Spoiler alert: not a single audited plan passed! From these results the 2024 legislation was born.
2024: New Rules, New Panic, High Cost for Compliance
The 2024 Final Rule added ingredients to the NQTL comparative analysis requirements. The requirements would impact group health plans beginning in 2025.
- The fiduciary attestation – this includes previous guidelines for overseeing the vendor evaluation, the review process of the vendor and assessing the results of the NQTL analysis. The 2024 rules said the fiduciary needed to sign an affidavit attesting to this. (Paused-2025)
- The “meaningful benefits” definition – travelback to the 2013 six categories; if the benefit is offered in one category it must be offered in all categories equal to M/S. The 2013 rule remains. The requirement to correct the discrepancy or a timeline in which to do so is the portion of the law on hold. Ex: If the plan covers testing for autism spectrum disorder (ASD) but excludes Applied Behavioral Analysis (ABA) the plan is not compliant – BUT the plan does not “necessarily” need to correct this failure in a specific time frame. (Paused-2025)
- Opt-out of MHPAEA for state/local group health plans – This exemption was removed, and these plans must now comply. (Applicable)
- DSM/ICD (Diagnostic and Statical Manual of Mental Health and International Classification of Diseases) compliance for MH/SUD diagnoses? If the diagnosis falls into the DSM and the ICD, the plan must have parity to how M/S conditions are treated. (Applicable)
2025: The Lawsuit and the “Great Pause”
From the time of the 2024 legislation there was great concern across the industry. ERIC (The ERISA Industry Committee), said, “Wait a minute—how can we comply with rules that are vague, unmeasurable, and based on FAQs instead of formal law?” ERIC argued: “How Do We Measure This?” ERIC challenged the courts with:
- How do you measure parity when plans don’t own the data (like provider networks)?
- How do you know if someone went out-of-network by choice or necessity?
- How do you compare MH/SUD services when costs, training, and burnout are so different?
- Overreaching of the Departments authority by using FAQ’s.
- Terminology vagueness and muddy standards for data outcomes.
- The details requested of the NQTL analysis cannot be performed with accuracy.
The Departments have officially said: “We’re not enforcing the 2024 Final Rule… for now.”
They’re reconsidering portions of the 2024 rule, and enforcement is paused for at least 18 months from the final litigation decision. But don’t get too cozy—quarterly updates are coming, and the pause could lift at any moment.
What Should Fiduciaries Do Now?
Even with the pause, fiduciaries are still on the hook:
- Hire a vendor.
- Oversee the NQTL analysis.
- Review the results.
- Be able to produce your comparative analysis.
- Be ready for when enforcement resumes.
- Don’t worry about the not so measurable changes in the NQTL test results.
Final Thoughts: Be prepared so you do not have to scramble
MHPAEA compliance isn’t going away — it’s just taking a “pause”. Use this time wisely. Complete your comparative analyses and stay tuned for updates from your EHD team.
And remember, compliance doesn’t have to be like eating liver and onions (unless you enjoy this). With the right staff in your kitchen, you can turn regulatory chaos into a Michelin-starred meal.
