Regulatory Updates
Regulatory Updates provide quick access to employee benefit regulations, rulings and other guidance released by governmental agencies in the U.S. and Canada.
New updates to this page may be included in Today’s Headlines which is emailed to International Foundation members each business day. Inquiries regarding these updates should be directed to the Benefits Knowledge Center at the International Foundation at (888) 334-3327, option 5 or [email protected].
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Departments Issue 2024 MHPAEA Report to Congress and FY 2023 Enforcement Fact Sheet
The Departments of Labor (DOL) Employee Benefits Security Administration (EBSA), Health and Human Services (HHS), and the Treasury issued the 2024 Report to Congress on the Mental Health Parity and Addiction Equity Act (MHPAEA) enforcement and implementation, which suggests that group health plans and health insurers are making progress complying with the MHPAEA, but restrictions for mental health and substance use disorder benefits persist.
A fiscal year 2023 MHPAEA enforcement fact sheet highlights enforcement data and significant results from MHPAEA investigations closed by EBSA and CMS.
As part of the report, the departments are releasing an unredacted 2024 settlement agreement between EBSA and a health plan that describes the actions the plan agreed to undertake to correct alleged violations of MHPAEA and illustrates the types of activities plans and issuers can undertake to monitor and address disparities in access to providers. The report also includes several examples that are based upon enforcement experience showing how plans and issuers can make corrections to comply with the law.
Appendix A – Sample Settlement Agreement between EBSA and a group health plan to address MHPAEA violations related to an NQTL relating to network composition and network adequacy. The terms of this settlement agreement address the specific violation and facts of this case. Other plans and issuers should take note of the types of activities this plan is undertaking to monitor and address disparities in access to providers.
- Table 1: Out-of-Network (OON) Utilization
- Sample chart format with OON categories to track separately
- Table 2: Network Providers Actively Submitting Claims
- Table 3: Wait Times for New and Existing Patients
- Data to report based on participant/patient surveys
- Table 4: Time & Distance Measurements
- Table 5: Provider-To-Member Ratios
- Table 6: Network Retention/Loss Analysis