The Gavel brings finality to The Mental Health Parity and Addictions Equity Act (MHPAEA)

The long-awaited final ruling of The Mental Health Parity and Addictions Equity Act (MHPAEA) has been made by the U.S. Departments of Health and Human Services (HHS), Labor (DOL), and Treasury (IRS) effective January 1, 2025. In 2021 the Consolidated Appropriations Act (CCA) amended the MHPAEA to require employers to perform an annual comparative analysis of the group health plans nonquantitative treatment limits (NQTLs) for mental health (MH) and substance use disorder (SUD) benefits compared to medical and surgical (M/S). NQTLs are benefit measurements other than financial and treatment limits on a covered benefit. Specifically, NQTLs include prior authorizations, provider admissions, network access and guidelines, step therapy, and the process for measuring usual, customary, and reasonable charges for MH/SUD benefits. Quantitative treatment limits (QTLs) are limitations associated with the number of days or visits.

 The final rule says these guidelines cannot be more restrictive or have a reduced benefit for MH/SUD compared to M/S benefits. The comparative analysis is designed to identify any inequalities between MH/SUD and M/S benefits. The access level must be equivalent to that of the M/S benefits. The classification of benefits measured by the condition or disorder must be equal to M/S classifications. Eliminate the state standard measurement for MH/SUD benefits setting the bar to current medical practice and independent guidelines as M/S are in the industry. In other words, bringing the standards of equality for all benefits to remove the shadow cast over MH/SUD treatment of care. The final rule is the removal of the ability of self-funded group health plans (GHPs) to opt out of MHPAEA compliance.

 Generally, a fully insured GHP comparative analysis is completed by the carrier, less so for self-funded GHPs.  The fiduciary of the GHP regardless of the plan funding avenue will need to attest that they were part of the analysis and review process. The comparative analysis must be produced if the Departments request it. The turnaround time for producing the analysis is 10 short days. A best practice strategy is completing the comparative analysis in advance.  This requirement should not have a shock level as it has been in place since February 2021. To date, there has not been any comparative analysis meeting the Department’s standard evaluation. If insufficient there will be 10 days to resubmit, if determined noncompliant the GHP will have 45 days to provide resolution and additional comparative analysis. In the end, if the analysis is deemed noncompliant, the GHP must notify all plan participants within 7 days.