MHPAEA Requirements and Nonenforcement Policy for 2024 Rules

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) generally requires parity between a group health plan’s medical/surgical (M/S) benefits and mental health/substance use disorder (MH/SUD) benefits. Plan sponsors should continue to ensure that they comply with MHPAEA and monitor any participant complaints and litigation regarding access to MH/SUD coverage under their group health plans. This update addresses a recently announced non-enforcement policy from the U.S. Departments of the Treasury, Labor, and Health and Human Services related to final MHPAEA regulations released in 2024.

As outlined below, the Departments made clear that MHPAEA’s requirement to have a written NQTL comparative analysis remains a requirement under the MHPAEA, and the non-enforcement policy on the 2024 regulations does not change that compliance obligation. Here are key headlines, including the welcome temporary non-enforcement policy from regulators.

• MHPAEA Requirements Generally – MHPAEA’s parity requirements apply to financial requirements (such as deductibles, copayments and coinsurance), quantitative treatment limitations or QTLs (such as day or visit limits), and non-quantitative treatment limits or NQTLs which generally limit the scope or duration of benefits (such as prior authorization requirements, step therapy requirements and standards for provider admission to participate in a network). These protections are intended to ensure that participants and other enrollees seeking MH/SUD benefits do not face greater limitations on access to those benefits than are imposed on M/S benefits.

  
  

• Comparative Analysis Required –  Since 2021, the Consolidated Appropriations Act of 2021 (CAA) has expressly required plans that provide both M/S benefits and MH/SUD benefits and that impose NQTL on MH/SUD benefits to perform and document comparative analyses of the design and application of NQTLs and make their analyses available to the Departments as applicable, or to an applicable State authority upon request. The CAA amendments also require the Departments to report to Congress annually on the results of NQTL comparative analyses reviews conducted by the Departments. See most recent Report to Congress here.

  
  

• MHPAEA Enforcement Top Priority – Health plan sponsors should be aware of the MHPAEA compliance requirements since enforcement related to MHPAEA has been a top priority for the federal agencies and the U.S. Department of Labor (DOL) is specifically focused on group health plans for adherence to these complex requirements. See the federal agency MHPAEA webpage for background on the law and enforcement efforts.

  
  

• 2024 Final Rules Issued – Late in 2024, the Departments finalized a set of rules (the 2024 Rules) that largely focused on requirements related to NQTLs. See our prior Update for background on the 2024 Rules which impose new requirements related to NQTLs and required group health plans to take many new significant steps to comply with the MHPAEA, including to:

  • Provide “meaningful” coverage for each MH/SUD condition in each classification for which a group health plan provides M/S benefits.

  • Collect and evaluate data that may indicate disparate participant access or use between M/S benefits and MH/SUD benefits and take reasonable action steps to address any differences.

  • Certify that they have engaged in a prudent process in preparing and evaluating their plan’s comparative analyses of its NQTLs.

    
    

Most of the 2024 Rules were effective for plan years beginning on January 1, 2025, while other parts, such as the new meaningful benefits standard and the data evaluation requirements, have a delayed effective date of the first plan year beginning on or after January 1, 2026.

Welcomed Non-Enforcement Policy for 2024 Rules

In response to a legal challenge to the 2024 Rules and a federal court’s decision to grant a pause, the Departments announced that they will not enforce the 2024 Rules or otherwise pursue enforcement actions, based on a failure to comply that occurs prior to a final decision in the litigation, plus an additional 18 months. The Departments’ motion is generally in line with the Trump administration’s April 9 presidential memoranda directing the heads of all executive departments and agencies to identify certain categories of unlawful and potentially unlawful regulations. The Departments nonenforcement policy relates to the 2024 Rules for the new requirements that apply for plan years beginning on or after January 1, 2025 and January 1, 2026.

Note that employers are still required to comply with MHPAEA. The Departments made clear that MHPAEA’s requirement to have a written NQTL comparative analysis remains a requirement under the MHPAEA, and the non-enforcement policy on the 2024 Rule should not change that compliance obligation.

Next Steps

• Plan fiduciaries should continue to review compliance with MHPAEA in general, and to ensure NQTL limitations are applied no more restrictively for MH/SUD benefits than for M/S benefits in the same classification.

  
  

• The NQTL comparative analyses report is statutorily required under the MHPAEA, so plan fiduciaries should continue to prepare and update the comparative analyses report and be ready to provide it upon request by regulators and participants.

  
  

• Although a fiduciary certification is not currently being enforced, plan fiduciaries should document their actions in complying with the MHPAEA and ensure prudent processes are followed.

  
  

Group health plans and insurers have struggled to comply with the 2024 Rules and are welcoming the temporary relief provided by the non-enforcement policy. For now, plans may continue to refer to the 2013 final rule, FAQs about MH/SUD parity implementation, and other MHPAEA sub-regulatory guidance.  The Departments intend to reexamine their enforcement approach under MHPAEA and may update the guidance as part of that process.

Conner Strong & Buckelew will continue to work with our clients to analyze and understand the complex requirements of the MHPAEA and to assist with the documentation of the NQTL comparative analysis as needed. We will provide alerts and updates as new information becomes available. Please contact your Conner Strong & Buckelew account representative toll-free at 1-877-861-3220 with any questions. For a complete list of Legislative Updates issued by Conner Strong & Buckelew, visit our online Resource Center.