Departments Issue Final Rule on Mental Health Parity Requirements

The departments of Health and Human Services (HHS), Labor, and the Treasury issued a Sept. 9 final rule (PDF)implementing provisions of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA, P.L. 110-343), as amended by the Consolidated Appropriations Act, 2021 (P.L. 116-260, PDF). The final rule reiterates and enforces the requirements of the MHPAEA that group and individual health plans offering mental health and substance use disorder services not be more restrictive in their coverage than their coverage of medical and surgical services. The MHPAEA's parity requirements apply to both quantitative limitations such as cost-sharing and visit limits as well as nonquantitative treatment limitations (NQTLs).

The rule also codifies requirements that health plans and issuers conduct comparative analyses to measure the impact NQTLs, such as network composition, out of network reimbursement rates, and medical management and prior authorization NQTLs. If a health plan is found to be noncompliant with the MHPAEA's requirements, the departments will give the plan 45 days to develop a corrective action plan. The final rule takes effect for group health plans and group insurance coverage on the first day of the first plan year beginning on or after Jan. 1, 2025, and Jan. 1, 2026, for individual health insurance plans. The AAMC had submitted comments on the August 2023 proposed rule, recommending increased reimbursement for mental and behavioral health services, as well as removal of barriers to treatment [refer to Washington Highlights, Sept. 29, 2023].