MHPAEA Basics
The Mental Health Parity and Addiction Equity Act (MHPAEA) requires that mental health and substance use disorder (MH/SUD) benefits be no more restrictive than medical/surgical benefits in the same classification. MHPAEA applies to group health plans with more than 50 participants and to health insurance issuers offering group or individual health insurance.
The 2024 Final Rule
The 2024 MHPAEA final rule significantly strengthened parity requirements. Key changes: (1) Plans must perform and document a comparative analysis of non-quantitative treatment limitations (NQTLs); (2) Plans must demonstrate that NQTLs are applied no more stringently to MH/SUD benefits than to medical/surgical benefits; (3) Plans must make the comparative analysis available to participants and regulators upon request.
FAB 2026-03: The Outcomes Shift
Compliance Note
The DOL's Field Assistance Bulletin 2026-03 (September 8, 2026) announced a significant shift in MHPAEA enforcement. Plans must now demonstrate parity through outcomes data — not just policy comparisons. Plans that cannot demonstrate comparable outcomes for MH/SUD and medical/surgical benefits will be presumed to be in violation. Review your comparative analysis for FAB 2026-03 compliance.