Self-funded plans are obligated to conduct a Mental Health Parity and Addiction Equity Act (MHPAEA) assessment, regardless of the status of the final regulations. The tri-agencies plan to release final rules by December 31, 2026. The requirement to prepare and maintain a Non-Quantitative Treatment Limitation (NQTL) comparative analysis was established under the Consolidated Appropriations Act, 2021 (CAA). It continues to apply to self-insured employers.
CAA statutory requirements are still in effect
The statutory language in the CAA requires plans to conduct the NQTL comparative analysis. Specifically, self-funded plans must be able to produce a written NQTL comparative analysis demonstrating parity between mental health/substance use disorder benefits and medical/surgical benefits, upon request by regulators or participants. Litigation related to the 2024 MHPAEA final rules hasn't eliminated or paused this requirement.
DOL enforcement continues
In addition, the U.S. Department of Labor continues to have a statutory duty to conduct MHPAEA audits, regardless of the administration in office. The Employee Benefits Security Administration continues to identify MHPAEA compliance as one of its top enforcement priorities.
Keep your assessment current
Accordingly, self-funded plans should ensure their MHPAEA assessment remains current. Comparative analyses aren't “one-and-done.” Plans should reassess and update their analysis on a regular cadence (ideally annually or every other year) and whenever:
- Plan design changes occur
- Change in vendors
- Significant change in demographics (often viewed as about 10%)
The Department of Labor still asks for comparative analyses during audits. Self-insured health plans are generally expected to produce a complete, defensible analysis within 10 business days. Not having a MHPAEA assessment available in the event of an audit or participant’s request may place clients at risk.
Action steps for plan sponsors
- Confirm you have a current, written NQTL comparative analysis on file that's complete and defensible
- Implement vendor governance as needed to demonstrate action is taken on known MHPAEA issues
- Establish an update cadence (annually or every other year) and refresh the analysis when plan design or vendor changes occur
- Check for demographic changes and reassess when there's a significant shift (about 10%)
