Mental Health Parity (MHPAEA) Toolkit

Practical Law Toolkit w-035-2601 (Approx. 8 pages)

Mental Health Parity (MHPAEA) Toolkit

by Practical Law Employee Benefits & Executive Compensation

Maintained • USA (National/Federal)

A collection of resources to help group health plan sponsors, health insurers, and their advisors understand and comply with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). MHPAEA and its implementing regulations impose extensive requirements regarding mental health parity on employer-sponsored group health plans and health insurers, including far-reaching proposed regulations issued by the administrative agencies in August 2023.

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) generally requires group health plans and health insurers to ensure that the financial requirements and treatment limitations for mental health or substance use disorder (MH/SUD) benefits they provide are no more restrictive than those for medical or surgical (M/S) benefits (Pub. L. No. 110-343 (2008), as amended by Pub. L. No. 110-460 (2008)). This is known as providing MH/SUD benefits in parity with M/S benefits.

MHPAEA's parity requirements were:

Amendments to the Employee Retirement Income Security Act of 1974 (ERISA), the Internal Revenue Code (Code), and the Public Health Service Act (PHSA).
Later amended by the Affordable Care Act (ACA) and the Consolidated Appropriations Act, 2021 (CAA-21).

In 2013, MHPAEA was implemented through final regulations issued by the Departments of Labor (DOL), Health and Human Services (HHS), and Treasury (collectively, Departments) (29 C.F.R. § 2590.712; 78 Fed. Reg. 68240 (Nov. 13, 2013)). MHPAEA has been the topic of extensive subregulatory guidance issued by the Departments, which includes numerous frequently asked questions and a self-compliance tool. (For a collection of this extensive guidance, see 88 Fed. Reg. 51552, footnotes 43-48 (Aug. 3, 2023).) In addition, MHPAEA-related challenges involving benefit denials and related claims brought by plan participants and beneficiaries have become one of the most litigated issues in the employee benefits space.

Enacted in December 2022, the Consolidated Appropriations Act, 2023 (CAA-23) also included several provisions addressing MHPAEA compliance (Pub. L. No. 117-328 (Dec. 29, 2022)). These provisions include:

Elimination of a PHSA provision that permitted self-funded, non-federal governmental plans to opt out of MHPAEA compliance (PHSA § 2722 (42 U.S.C. § 300gg-21); see Practice Note, Public Health Service Act (PHSA) Compliance Opt-Out Election for Self-Funded, Non-Federal Governmental Plans).
State grants for MHPAEA enforcement, including with comparative analyses under the CAA-21 (see Practice Note, Mental Health Parity Requirements Under the CAA-21: Comparative Analysis (CA) Disclosures: Compliance with NQTL Requirements).

For more information, see Legal Update, Year-End CAA-23 Legislation Extends Access to Telehealth Services.

In August 2023, the Departments also issued extensive proposed regulations and related guidance that would, among other changes:

Expand existing NQTL standards to prevent plans and insurers from using NQTLs to place greater limits on access to MH/SUD benefits compared to M/S benefits.
Require plans and insurers to collect and evaluate outcomes data and take steps to address material differences in access to MH/SUD benefits relative to M/S benefits, including to ensure that there are not material differences in access due to the application of network composition standards.
Establish minimum standards for developing CAs that evaluate the design and application of NQTLs (as written and in operation) and determine whether NQTLs are MHPAEA-compliant.

For more information, see:

To assist health plan sponsors, health insurers, third-party administrators (TPAs), and their advisors in complying with MHPAEA's complex and expanding requirements, this Toolkit provides a collection of continuously updated resources that address various aspects of mental health parity compliance.

For related resources addressing attorney well-being, see Legal Operations, Professional Development & Well-Being Toolkit: Managing Career and Well-Being.

Mental Health Parity (MHPAEA) Toolkit | Practical Law