MHPAEA comparative analysis requirements for 2025

New MHPAEA Requirement for 2025: Are You Ready?

Every Health & Welfare ERISA Fiduciary should have this on their to-do list.
(Even better if it’s already on the “done” list.)

For years, plans have been required to conduct a comparative analysis of their nonquantitative treatment limitations (NQTLs).

In plain English: make sure mental health/substance use disorder benefits aren’t treated less favorably than medical/surgical benefits.

But here’s the big shift for 2025: Fiduciaries now have to show their work.

That means:

1. Confirm a qualified provider was selected and monitored for the comparative analysis.

2. Understand the findings and conclusions.

3. Assure compliance with MHPAEA rules.

What are some common NQTLs?

• Medical management standards limiting/excluding benefits.

• Formulary design for prescription drugs.

• Network tier design.

• Standards for provider admission, including reimbursement rates.

• Usual, customary, and reasonable charge determinations.

• Fail-first policies or step therapy protocols.

• Restrictions based on geography, facility type, or provider specialty.

When:

• Calendar-year plans: January 1, 2025.

• Fiscal-year plans: First day of the 2025 plan year.

Warning Signs for NQTL Compliance (According to the DOL):

• Excluding mental health/substance use disorder treatments covered for medical/surgical services.

• Imposing stricter prior authorization or step therapy for behavioral health care.

• Lower reimbursement rates for behavioral health providers.

• Geographic restrictions on mental health treatment coverage.

(Find the DOL Warning Signs List for NQTLs here: https://lnkd.in/eVbxauea)

Takeaway:
If you’re a fiduciary, the time to act is now.

What do you think?

• Will this requirement be strictly enforced?

• What penalties might fiduciaries face if they fail to comply?

• Could enforcement priorities shift under the next administration?