MH/SUD parity final rules (MHPAEA)
Governs implementation of the Departments' September 9, 2024 final rules amending MHPAEA requirements for group and individual health plans, detailing NQTL comparative analyses, meaningful benefits, outcomes data, and documentation; affects group health plans, issuers, and applicable state authorities.
Final rules issued September 9, 2024 amend MHPAEA and add new implementing requirements.
Plans and issuers must define MH conditions and SUDs consistent with the current ICD or DSM.
Plans must offer meaningful benefits, including a core treatment, for each covered MH condition or SUD in every classification where M/S core treatments are offered.
Plans may not use factors or evidentiary standards to design NQTLs that discriminate against MH/SUDs.
Plans must collect and evaluate outcomes data and take reasonable action to address material differences in access to MH/SUD benefits versus M/S benefits.
Comparative analyses must include specified elements, be made available on request, and ERISA plans must certify use of a prudent process and monitoring of service providers.
State and local government health plans can no longer opt out of MHPAEA compliance.
MH/SUD Parity Coverage Requirements
MH/SUD parity requirements
Coverage and parity requirements under the final rules include:
ALL of the following must be met:
- Define whether a condition or disorder is an MH condition or SUD in a manner that is consistent with the most current version of the International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders.
- Offer meaningful benefits (including a core treatment) for each covered MH condition or SUD in every classification in which medical/surgical (M/S) benefits (a core treatment) are offered.
- Not use factors and evidentiary standards to design nonquantitative treatment limitations (NQTLs) that discriminate against MH conditions and SUDs.
- Collect and evaluate relevant outcomes data and take reasonable action, as necessary, to address material differences in access to MH/SUD benefits as compared to M/S benefits.
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