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In 2024, the federal government remains committed to enhancing accessibility to mental health and substance use disorder (MH/SUD) care, with a key focus on ensuring compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) for health plans sponsored by employers.
MHPAEA is a federal law that ensures that group health plans and health insurance issuers offering MH/SUD benefits cannot impose stricter limitations on these benefits compared to what is typically applied to similar medical or surgical benefits.
The enforcement of MHPAEA falls under the jurisdiction of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA). In a recent report to Congress in July 2023, it was revealed that EBSA dedicates almost a quarter of its enforcement efforts to addressing nonquantitative treatment limitations (NQTLs) related to MHPAEA. Should violations be identified by an EBSA investigator, the health plan is required to rectify any noncompliant provisions and ensure that any denied benefits are rightfully paid out.
Mental Health Parity
MHPAEA ensures parity for MH/SUD benefits in group health plans, applicable to employers with over 50 employees. Non-grandfathered small group plans must comply with MHPAEA.
Employers must ensure that their health plan vendors comply with MHPAEA to protect themselves from enforcement actions and lawsuits. Monitoring compliance and maintaining documentation is key. Addressing barriers to mental health care can lead to a more productive workforce and positive company culture.
Parity Requirements
MHPAEA mandates that financial and treatment requirements for MH/SUD benefits must be no more stringent than those for medical/surgical benefits. It also enforces parity on NQTLs for MH/SUD benefits, including standards for network composition and comparative analysis.
A proposed rule issued in August 2023 would make extensive changes to MHPAEA's requirements, particularly for NQTLs. It mandates health plans to collect and analyze data on MH/SUD coverage access compared to medical/surgical coverage, rather than relying solely on coverage descriptions. The rule also sets a special standard for NQTLs regarding network composition and establishes additional criteria for comparative analysis.
Comparative Analysis
MHPAEA requires health plans and issuers to conduct detailed comparative analyses of NQTLs for medical/surgical versus MH/SUD benefits, ensuring compliance with written explanations. Plans must submit these analyses to authorities, aiming for adequacy and compliance with EBSA guidelines.
MHPAEA Enforcement
EBSA enforces MHPAEA requirements for private-sector health plans, conducting compliance reviews and addressing violations by requesting necessary changes and benefit payments, and notifying affected individuals.
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National Insurance Services is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Readers are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to the readers’ business activities.
