On September 9, 2024, the US Departments of Health and Human Services (HHS), Labor, and the Treasury (collectively, the Departments) finalized a rule titled Requirements Related to the Mental Health Parity and Addiction Equity Act. The rule makes several changes related to mental health (MH) parity for group and individual health plans, including:
- Creating additional protections against more restrictive non-quantitative treatment limitations (NQTLs) for MH and substance use disorder (SUD) benefits compared to medical or surgical benefits.
- Clarifying definitions.
- Codifying requirements of the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Consolidated Appropriations Act, 2021 (CAA, 2021).
- Requiring plans and issuers to collect and evaluate data and take reasonable action as necessary to address material differences in access to MH/SUD benefits as compared to medical/surgical benefits.
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The Departments also developed a new set of templates and guides for Medicaid state agencies to document how MH and SUD benefits provided through a state’s Medicaid managed care program, Medicaid alternative benefit plans (ABPs), or Children’s Health Insurance Program (CHIP) comply with Medicaid and CHIP MHPAEA requirements.
The Departments issued the proposed rule in July 2023 and received more than 9,000 comments during the comment period. Overall, the final rule largely mirrors the proposed rule.
The final rule generally applies to group health plans and group health insurance coverage on the first day of the first plan year beginning on or after January 1, 2025. However, 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 apply on the first day of the first plan year beginning on or after January 1, 2026. The final rule applies to health insurance issuers offering individual health insurance coverage for policy years beginning on or after January 1, 2026.
Key Takeaways
- The Departments clarified that the MHPAEA protects plan participants, beneficiaries, and enrollees from facing greater restrictions on access to MH/SUD benefits compared to medical and surgical benefits.
- The definitions set forth in the proposed rule were largely finalized as proposed, with small changes to add clarity and specificity.
- The Departments finalized their “meaningful benefits” standard, which requires that if a plan provides benefits for an MH condition or SUD in any classification of benefits, those benefits must be “meaningful” when compared to benefits provided for medical conditions and surgical procedures in that classification.
- The Departments modified and reduced their proposed additional requirements that apply to NQTLs.
- The Departments finalized requirements related to the content of comparative analyses for NQTLs, how these analyses are submitted to the Departments, and what actions plans must undertake if the Departments determine plans are not in compliance with the MHPAEA.
- The Centers for Medicare & Medicaid Services (CMS) seeks comments on a set of templates and instructional guides for state agencies to document how MH/SUD benefits provided through a state’s Medicaid managed care program, Medicaid ABP, or CHIP comply with MHPAEA requirements.
- The prohibition on financial requirements and treatment limitations for MH/SUD benefits was finalized as proposed.
- The Departments finalized largely as proposed an enforcement structure for initial and final determinations of noncompliance with the MHPAEA. The final rule includes 13 hypothetical examples illustrating compliance and noncompliance, including actions the Departments will take in instances of noncompliance.
