Compliance News Week Ending January 24, 2025

In this Article

MHPAEA (Mental Health Parity and Addiction Equity Act) - Agencies' Report to Congress

Updated ERISA Penalties for 2025

MHPAEA (Mental Health Parity and Addiction Equity Act) – Agencies' Report to Congress

The report released last Friday provides an overview of the agencies' enforcement efforts and findings regarding compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) from mid-2022 to mid-2023.

Audits uncovered ongoing issues with network adequacy (limited access) and impermissible exclusions for key treatments of covered mental health and substance use disorder conditions, amongst other things, and required several plans to not only make changes going forward but to also reprocess claims retroactively. In addition, as most comparative analyses provided upon request were found to be incomplete, the report suggests "plans and issuers should aim to provide detailed comparative analyses and supporting documentation, and they can expect full investigations of operations related to NQTLs if they fail to do so."

MHPAEA enforcement has been a priority in recent years and the report suggests that guidance and enforcement will continue to be a priority. As of today, it will be waiting to see how this plays out under the new administration, including enforcement of the changes set forth in final rules issued in September 2024.

The News Release, including links to a Fact Sheet and the Report to Congress.

Updated ERISA Penalties

The Department of Labor (DOL) released updated ERISA civil monetary penalty amounts for 2025.

For failure to file a Form 5500, the penalty increased to $2,739 per day late (previously $2,670).

For failure to distribute the summary of benefits and coverage (SBC), the penalty increased to $1,443 per failure (previously $1,406).

The updated penalties are documented in the Federal Register.

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