Key Insights from the Latest MHPAEA Regulations: What Employers Need to Know Now

In the third webinar of our series on the Mental Health Parity and Addiction Equity Act (MHPAEA), John Barlament, a Shareholder at Reinhart Boerner Van Deuren, provided essential guidance on the recently updated MHPAEA regulations and the actions employers should take to remain compliant. These new regulations are pivotal in supporting mental health parity. And employers must act swiftly to understand and implement these changes. Keep reading to get the key insights from the presentation. You can also watch the third MHPAEA webinar on-demand. 

A Recap of the MHPAEA 

MHPAEA is a federal law mandating that group health plans offer equal treatment for mental health and substance use disorder (MH/SUD) services and medical/surgical (M/S) services. This parity is achieved through these main requirements: 

1. Annual and Lifetime Limits: Plans with annual or lifetime dollar limits for M/S benefits must apply those same limits (or higher) to MH/SUD benefits.
2. Financial Requirements: Cost-sharing methods like coinsurance, copayments, and deductibles for MH/SUD benefits must not be more restrictive than those for M/S benefits.
3. Quantitative Treatment Limitations (QTLs): Limits on the number of visits or treatment sessions for MH/SUD benefits cannot be more restrictive than those for M/S benefits.
4. Parity in Non-Quantitative Treatment Limitations (NQTLs): Rules such as prior authorization, step therapy, and provider networks must be applied comparably for MH/SUD and medical/surgical services.

For a deeper dive, you can read the key takeaways from part 1 and part 2 of the MHPAEA series. 

New MHPAEA Regulations: What’s Changing? 

On September 9, 2024, the US Department of Health and Human Services (HHS), the US Department of Labor (DOL), and the US Department of the Treasury issued final rules revising MHPAEA requirements and adding new provisions. These new rules revise the existing MHPAEA regulations. They also introduce additional requirements outlining the content and timelines for responding to requests for non-quantitative treatment limitation (NQTL) comparative analyses, as mandated by the 2021 Consolidated Appropriations Act (CAA). 

These rules aim to strengthen MHPAEA’s core objective: ensuring that individuals in group health plans or individual health insurance coverage who seek treatment for mental health (MH) or substance use disorders (SUDs) do not face greater barriers to access than they would face for medical or surgical treatments.  

Understanding the Two-Part NQTL Test 

The new regulations require a two-part non-quantitative treatment limitation (NQTL) test. This framework addresses how health benefit plans apply NQTLs and ensures benefit plans cannot impose NQTLs for MH/SUD benefits that are more restrictive than the “predominant” NQTL that applies to M/S benefits. 

The two-part test includes the design and application rule and the required use of outcomes data rule.  

1. Design and Application Rule: This requires that any processes, strategies, or evidentiary standards used in applying NQTLs to MH/SUD benefits must be comparable to those used for M/S benefits within the same classification. Additionally, these standards must align with recognized guidelines like the International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders (DSM) to avoid biased or subjective decision-making.

2. Required Use of Outcomes Data Rule: Effective January 1, 2026, plans must collect and analyze data to assess the impact of NQTLs on access to MH/SUD benefits. This means plans must regularly review data that could indicate differences in access. And, they should make adjustments if barriers to MH/SUD access are identified.

Gathering and Evaluating Relevant Data 

The new regulations also require plans to gather relevant data for assessing how NQTLs impact access to MH/SUD benefits. This data must be used to determine if there are material differences in how MH/SUD and M/S benefits are accessed. This could include:

Plans must document reasons for unavailable data, specify alternative sources, and outline steps to obtain the missing data. If data cannot be acquired, plans must provide a detailed justification and a summary ensuring parity.

Corrective Actions for Non-Compliance 

Under the new guidelines, if data indicates that NQTLs are more restrictive for MH/SUD benefits than M/S benefits, employers must take corrective action. This could involve updating standards, revising policies, or modifying network arrangements. Employers should collaborate with TPAs and PBMs to analyze outcomes and document corrective actions regularly. Plans that ignore non-compliance signs or data on MH/SUD access barriers may face penalties or increased scrutiny.

Special Requirements for Network Composition 

The final regulations emphasize network composition as a key area of compliance. Plans must ensure that NQTLs do not restrict access to MH/SUD providers compared to M/S providers, focusing on several areas: 

Employers may need to increase telehealth options, enhance recruitment efforts, or streamline credentialing processes for MH/SUD providers. This can address gaps in network adequacy. The Alliance’s networks include a range of mental and behavioral healthcare providers, including independent and virtual providers to increase access to these services.  

How Employers Can Prepare for the Upcoming MHPAEA Deadlines 

The new MHPAEA regulations mark a shift in how employers must approach parity in mental health benefits. By understanding the changes to the regulations and taking early action, employers can ensure compliance and demonstrate their commitment to mental health equity. For further insights, view our full MHPAEA webinar series on YouTube.