Mental Health Parity Enforcement:

Agencies’ Report to Congress

The report released last Friday provides an overview of the agencies’ enforcement efforts and findings regarding compliance with the Mental Health Parity & Addiction Equity Act (MHPAEA) from mid-2022 to mid-2023. 

Audits uncovered ongoing issues with network adequacy (limited access) and impermissible exclusions for key treatments of covered mental health and substance use disorder conditions, amongst other things, and required several plans to not only make changes going forward but to also reprocess claims retroactively.

In addition, as most comparative analyses provided upon request were found to be incomplete, the report suggests “plans and issuers should aim to provide detailed comparative analyses and supporting documentation, and they can expect full investigations of operations related to NQTLs if they fail to do so.” 

MHPAEA enforcement has been a priority in recent years and the report suggests that guidance and enforcement will continue to be a priority. We’ll have to wait and see how this plays out under the new administration, including enforcement of the changes set forth in final rules issued in September 2024. The News Release, including links to a Fact Sheet and the Report to Congress can be found here.

IMA will continue to monitor regulator guidance and offer meaningful, practical, timely information. This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.

Author