Employers that sponsor self-insured health plans need to make sure their plans will be in compliance with new rules under the Mental Health Parity and Addiction Equity Act, as amended (the “MHPAEA”), effective January 1, 2025.

MHPAEA seeks to ensure that group health plans make it no more difficult for participants and beneficiaries to access mental health and substance use-related benefits than medical or surgical benefits.

Though the compliance date for more onerous requirements of the MHPAEA regulations (including related to the meaningful benefits standard, the prohibition on discriminatory factors and evidentiary standards, the relevant data evaluation requirements, and the related requirements in the provisions for comparative analyses) is not until January 1, 2026 (for calendar-year plans), the effective date for certain requirements under the MHPAEA quickly approaches on January 1, 2025.

As of January 1, 2025, the MHPAEA will require group health plans to prepare comparative analyses regarding non-qualitative treatment limitations (“NQTLs”) – non-financial restrictions on benefits that can limit the length or scope of covered treatment for mental health and substance use-related benefits relative to those for medical or surgical benefits – based on the following 6 content elements:

  1. Describe the NQTL, including identifying benefits subject to the NQTL;
  2. Identify and define the factors and evidentiary standards used to design/apply the NQTL;
  3. Describe how factors are used in the design or application of the NQTL;
  4. Demonstrate comparability and stringency, as written;
  5. Demonstrate comparability and stringency, in operation, including the required data, evaluation of that data, explanation of any material differences in access, and describe reasonable actions taken to address such differences; and
  6. Include findings and conclusions.

On October 18, a DOL official stated that the DOL expects to issue additional guidance regarding the data it expects employers to collect to perform such comparative analyses, including the “type, form and manner of collection and evaluation of data”.

Enforcement related to the use of the content elements set forth above in NQTL comparative analyses will begin in 2026.

Given the fiduciary obligations associated with plan administration, plan sponsors should likely partner with third-party administrators or benefits consultants to align NQTL comparative analyses with the requirements of the MHPAEA and ensure ongoing compliance, and work with ERISA counsel to document same.