Mid-Atlantic Health Law TOPICS

On September 9, 2024, the Departments of Labor, Health and Human Services, and Treasury issued an updated Mental Health Parity final rule (Final Rule), setting forth new requirements for compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) as amended by the Consolidated Appropriations Act, 2021.  

MHPAEA requires large group health plans that cover mental health and/or substance abuse disorder benefits to provide access to those benefits in a similar manner as the plan provides access to medical/surgical benefits.

The Final Rule applies to individual and group fully insured plans and self-funded group health plans (collectively, Plans). The Final Rule applies to plan years beginning on or after January 1, 2025.  

NQTLs

The Final Rule adds new regulations for nonquantitative treatment limitation (NQTL) comparative analyses to ensure that NQTLs do not impose greater restrictions on mental health and substance use disorder benefits compared to medical/surgical benefits, and requires Plans to collect and evaluate relevant data to assess the impact of NQTLs on access to benefits. 

NQTLs are non-numerical tools used by Plans, such as prior authorizations or the use of less expensive drugs before “stepping up” to more expensive drugs, that help Plans control the cost of care.

Legal Challenge

The ERISA Industry Committee (ERIC), a nonprofit organization representing the largest employers in the United States, filed a lawsuit on January 16, 2025, challenging the Final Rule. 

In the complaint, ERIC claims that the Final Rule “upends the regulatory and compliance framework that has evolved over decades” and “imposes entirely new, ambiguous requirements that are so burdensome and unworkable that they will discourage employers from offering MH/SUD benefits at all.” 

ERIC also ironically asserts that the Final Rule creates a mental health benefits mandate which the statute clearly does not support. 

With the overturning of the Chevron Doctrine in Loper Bright Enterprises v. Raimondo, the federal agencies will not receive as much deference to their interpretation of the law from a reviewing court, and, therefore, ERIC’s suit may succeed. Further, it is unclear to what extent the Trump Administration will seek to enforce the Final Rule which was adopted at the end of the departing Biden Administration.
 

Darci M. Smith
410-576-4153 • dsmith@gfrlaw.com