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Health & Welfare Plans Newsletter

July 25, 2023


[Official Guidance]

Text of Agency Proposed Regs: Requirements Related to the Mental Health Parity and Addiction Equity Act: (PDF)

395 pages. "This document proposes amendments to regulations implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and proposes new regulations implementing the nonquantitative treatment limitation (NQTL) comparative analyses requirements under MHPAEA... Specifically, these proposed rules would amend the existing NQTL standard to prevent plans and issuers from using NQTLs to place greater limits on access to mental health and substance use disorder benefits as compared to medical/surgical benefits. As part of these changes, these proposed rules would require plans and issuers to collect and evaluate relevant data in a manner reasonably designed to assess the impact of NQTLs on access to mental health and substance use disorder benefits and medical/surgical benefits, and would set forth a special rule with regard to network composition. ... [T]hese proposed rules would set forth the content requirements for NQTL comparative analyses and specify how plans and issuers must make these comparative analyses available to the Department of the Treasury, the [DOL], and [HHS], as well as to an applicable State authority, and participants, beneficiaries, and enrollees. The Departments also solicit comments on whether there are ways to improve the coverage of mental health and substance use disorder benefits through other provisions of Federal law. Finally, HHS proposes regulatory amendments to implement the sunset provision for self-funded, non-Federal governmental plan elections to opt out of compliance with MHPAEA, as adopted in the Consolidated Appropriations Act, 2023."  MORE >>

U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department

[Official Guidance]

Text of EBSA Technical Release 2023-01: Request for Comments on Proposed Relevant Data Requirements for NQTLs Related to Network Composition and Enforcement Safe Harbor for Group Health Plans and Health Insurance Issuers Subject to the MHPAEA

"This Technical Release sets out principles regarding the relevant data that group health plans and health insurance issuers would be required to collect and evaluate for NQTLs related to network composition to demonstrate compliance with the [MHPAEA] and seeks public comments to inform guidance under the notice of proposed rulemaking released by the Departments of the Treasury, [DOL], and [HHS].... The Departments are particularly concerned about how NQTLs related to network composition affect access to MH/SUD benefits, as these inherently impact a participant's, beneficiary's, or enrollee's access to MH/SUD providers.... The potential enforcement safe harbor would, if satisfied, provide sufficient evidence to demonstrate to the Departments that participants, beneficiaries, and enrollees in the plan or coverage would have comparable access to in-network MH/SUD and M/S providers."  MORE >>

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

[Guidance Overview]

EBSA, HHS and Treasury MHPAEA Guidance Compendium

"This document provides the citations to the MHPAEA Final and Interim Final Rules and the guidance the Departments have issued for each category of violation cited in DOL's and HHS's FY22 MHPAEA Enforcement Fact Sheet."  MORE >>

U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department

EBSA MHPAEA Comparative Analysis Report to Congress, July 2023

"This report focuses on the Departments' enforcement efforts regarding NQTLs during the second year of implementation of the CAA amendments to MHPAEA. This report also looks broadly at the 18-month period since plans and issuers were first required to make their comparative analyses available on request. In addition to a discussion of common deficiencies in NQTL comparative analyses submitted by plans and issuers during the Reporting Period, this report includes, as required by the CAA, the identity of each plan and issuer that received a final determination of non-compliance. Finally, this report also highlights certain information that was provided by plans and issuers in response to the Departments' NQTL comparative analyses requests that either addressed an aspect of an identified deficiency or satisfied EBSA's or CMS' inquiry into the NQTL altogether."  MORE >>

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

FY 2022 MHPAEA Enforcement Fact Sheet

"This enforcement fact sheet summarizes EBSA's and CMS's closed investigations and public inquiries related to MHPAEA during fiscal year (FY) 2022 ... During FY 2022, in response to requirements imposed on plans and issuers by the Consolidated Appropriations Act, 2021 (CAA), EBSA and CMS significantly increased their nonquantitative treatment limitation (NQTL) enforcement activity. However, this fact sheet does not fully capture results from EBSA's and CMS's increased activity because many of these investigations were ongoing at the end of FY 2022.... If EBSA or CMS cited a MHPAEA NQTL violation, including violations of the CAA's comparative analysis requirements, and the investigation was closed during FY 2022, the results of those investigations and any corrective actions are also captured in this fact sheet."  MORE >>

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL], and Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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BenefitsLink® Retirement Plans Newsletter, ISSN no. 1536-9587.

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