The final rules for the Mental Health Parity and Addiction Equity of 2008 (MHPAEA) were released on September 9, 2024, by the Department of Health and Human Services, Labor, and the Treasury in order to guarantee that those seeking treatment for mental health (MH) or substance use disorder (SUD). MHPAEA provides nonquantitative treatment limitations (NQTLs) cannot be applied to MH/SUD unless they are equivalent and applied no more strictly for MH/SUD benefits than for medical/surgical benefits.
The final rules amend the definitions of definition of “medical/surgical”, “mental health benefits”, and “substance use disorder benefits” by removing a reference to the state guidelines. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, also known as the International Classification of Diseases, must be used to determine whether a condition or disorder qualifies as an SUD or an MH condition.
The following conditions are confirmed to be mental health issues by the regulations:
- Eating disorders such as anorexia nervosa, bulimia nervosa, and binge-eating disorder
- Autism spectrum disorder
- Gender dysphoria
Additionally, the final rules add new definitions for the following terms: evidentiary standards, factors, processes and strategies.
Requirements for NQTLs
As per the final regulations, no plan or carrier is allowed to impose a more restrictive NQTL, either in writing or in practice, than the predominant NQTL that covers almost all medical/ surgical benefits in the same classification regarding MH/SUD benefits. A plan or carrier must meet the following two requirements:
- The design and application requirements
- The relevant data evaluation requirements.
With the effect date of June 27, 2023, the final regulation carries out the sunset clause allowing self-funded non-governmental plans to choose not to comply with MHPAEA.
Dates of effectiveness starting January 1, 2025, and continuing through the first day of the plan year thereafter, the final regulations will generally apply to group health plans and group health insurance coverage. This covers the new fiduciary certification requirement.
Have Questions? and want to read more about the changes? Check Departments Issue Final MHPAEA Regulations for more details
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