In this post, we’ll cover:
- MHPAEA (Mental Health Parity and Addiction Equity Act): Agencies’ Report to Congress
- Updated ERISA Penalties for 2025
MHPAEA – Agencies’ Report to Congress
Last Friday, a new report was released detailing federal agencies’ efforts to enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) from mid-2022 through mid-2023.
Key findings from the report highlight:
- Network Adequacy Issues: Limited access to mental health providers remains a significant concern.
- Impermissible Treatment Exclusions: Some plans excluded critical treatments for covered mental health and substance use disorders.
- Claim Reprocessing Requirements: Certain plans were mandated to not only improve their compliance moving forward but also reprocess past claims retroactively.
One critical observation was the inadequacy of comparative analyses provided by many plans upon request. These analyses were often incomplete, prompting the report to advise that plans and issuers:
- Prepare detailed comparative analyses.
- Include supporting documentation for all processes.
- Expect thorough investigations into non-quantitative treatment limitations (NQTLs) if documentation is insufficient.
The enforcement of MHPAEA has been a high priority in recent years, and the report indicates this trend will likely continue. It remains to be seen how these efforts evolve under the current administration, particularly in light of the final rules issued in September 2024.
For more information, check out the news release with links to the Fact Sheet and the full Report to Congress.
Updated ERISA Penalties for 2025
The Department of Labor (DOL) has announced updated civil monetary penalties under ERISA for 2025. Here’s what’s new:
- Failure to File Form 5500: Penalty increased to $2,739 per day (up from $2,670).
- Failure to Distribute the Summary of Benefits and Coverage (SBC): Penalty increased to $1,443 per failure (up from $1,406).
Employers and plan administrators should take note of these changes to avoid costly penalties.
Stay tuned for more updates on compliance and regulatory changes!