Various Requirements and Deadlines under the Final Regulations Related to MHPAEA
Employee Benefits
Various Requirements and Deadlines under the Final Regulations Related to the Mental Health Parity and Addiction Equity Act (MHPAEA)
Background
On November 13, 2013, the Department of Labor, Department of Treasury, and Department of Health and Human Services (hereinafter referred to as “the Departments”) issued final rules implementing and establishing the basis for the Mental Health Parity and Addiction Equity Act (MHPAEA) rules as we know them today.
These final rules created six (6) classifications of benefits when comparing parity between MH/SUD benefits and M/S benefits:
- Inpatient, in-network
- Inpatient, out-of-network
- Outpatient, in-network
- Outpatient, out-of-network
- Emergency care
- Prescription drugs
The 2013 final rules provided that, consistent with the statute, plans cannot “impose a greater burden on access” (more restrictive conditions) to mental health/substance use disorder (MH/SUD) benefits under the plan “than they impose on access to medical/surgical (M/S) benefits in the same classification…” These requirements apply to the financial requirements (e.g., copayments, deductibles) and the numerically expressed quantitative treatment limitations (QTLs) (e.g., maximum number of visits to a doctor) within a health plan. They also apply to the non-quantitative treatment limitations (NQTLs) (e.g., non-numerical health plan requirements such as prior authorization requirements, step therapy and provider admission requirements) within a health plan.
On December 27, 2020, the CAA 2021 amended MHPAEA, expressly requiring group health plans (sponsored by employers with 50 or more employees) and insurers to document and perform an NQTL analysis to determine whether a plan’s design and application of NQTLs are more stringent on MH/SUD benefits as compared to M/S benefits. The effective date of this requirement was February 10, 2021. The Departments have released multiple sets of fact sheets, compliance assistance tools, templates, reports and publications since the inception of MHPAEA.
On September 23, 2024, the Departments published final rules (Requirements Related to the Mental Health Parity and Addiction Equity Act) specifically relating to NQTLs and a Fact Sheet summarizing the final rules. The following charts illustrate the various requirements and deadlines under the final rules.
