On September 9, 2024, the Department of Labor, the Department of the Treasury, and HHS (the Departments) jointly issued a final rule (the Final Rule) amending regulations implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). MHPAEA is a landmark federal law intended to increase access to treatment for mental health and substance use disorders. Although MHPAEA was passed over fifteen years ago, challenges with enforcement and implementation have persisted, leading to this joint final rule that the Departments proposed in July 2023 to strengthen MHPAEA.
In proposing and finalizing this Final Rule, the Departments sought to address what they consider a mental health and substance use disorder crisis. They identified continuing disparities in access to mental health and substance use disorder (MH/SUD) benefits and medical/surgical (M/S) health insurance benefits. Through this Final Rule, the Departments sought to strengthen MHPAEA enforcement and ensure that individuals seeking treatment for covered MH conditions or SUDs do not face greater burdens on access to benefits for those conditions or disorders than they would face when seeking coverage for the treatment of a medical condition or a surgical procedure.
Key provisions of the Final Rule include the following:
- Health plans may not impose any nonquantitative treatment limitations (NQTLs–rules that are not expressed numerically such as medical management standards or standards for provider admission to a network) to MH/SUD benefits in any classification that is more restrictive than the predominant NQTL that applies to M/S benefits in the same classification.
- Plans must collect relevant outcome data to assess the impact of NQTLs on MH/SUD benefits and then take reasonable action to address any material differences in access to in-network MH/SUD services as compared to M/S services.
- If a plan provides coverage of any benefits for a MH/SUD condition, it must also provide meaningful benefits for that condition in every classification for which meaningful M/S benefits are provided. “Meaningful benefits” are determined by comparing the benefits provided for an M/S condition to the MH/SUD benefits in the same classification.
- The Final Rule prescribes in detail the content needed for the comparative analysis of NQTLs and the timeframes for plans to take remedial actions and make required disclosures.
The Final Rule also implements the “sunset provision” for self-funded non-federal governmental plan elections to opt out of compliance with MHPAEA. The Final Rule generally takes effect for group health plans and group health insurance coverage on the first day of the first plan year beginning on or after January 1, 2025. Certain other provisions take effect on the first day of the first plan year beginning on or after January 1, 2026, such as for the meaningful benefits standard and the relevant data evaluation requirements.
The Final Rule can be accessed here. Additionally, the Fact Sheet for the Final Rule is available here.
