The Department of Labor (DOL) updated the Mental Health Parity and Addiction Equity Act (MHPAEA) Self-Compliance Tool. This improved tool is intended to help group health plans and plan sponsors of self-funded plans determine if the plan complies with the rules relating to mental health and substance-use disorder benefits.
What is the MHPAEA?
In general, under the MHPAEA, a group health plan or health insurance issuer that imposes financial requirements and treatment limitations on mental health and substance use disorder benefits must ensure those limitations are comparable to and applied no more stringently than those that apply to medical and surgical benefits. Financial requirements include cost-sharing requirements such as deductibles, copays, and coinsurance. Treatment limitations include quantitative and non-quantitative limits on the scope or duration of treatment, such as visit limits or prior authorization.
Why New Rules Now?
Under the 21st Century Cures Act, Congress directed the U.S. Departments of Labor, Health and Human Services, and the Treasury to issue a compliance program guidance document to improve compliance with the MHPAEA, and to update this guidance document every two years. The last time this tool was updated is 2018.
What are the Changes?
Changes include the addition of non-compliance warning signs or red flags when different factors are considered to determine the provider reimbursement rate. It is advisable to take a closer at these scenarios to ensure compliance. Additional changes include:
- Page 22 – Clarification that requirements for Non-Quantitative Treatment Limitations (NQTLs) apply to methods for establishing both in-network and out-of-network provider reimbursement rates.
- Additional examples -Types of records that would be required to be provided in the event of a DOL investigation, including, whether an internal compliance plan is a requirement.
- The new example demonstrates how an internal compliance strategy would help plans improve compliance with the law.
- Page 18 – Additional warning signs added related to specialist copayments. Explaining when such a specialist copay would be permitted for mental health and substance use disorder benefits.
For further explanation of the changes incorporated into the updated tool, see the corresponding preface.
Action May be Required
Plan sponsors of self-funded plans that have complicated reimbursement rates and coinsurance requirements are strongly encouraged to utilize the updated tool. The contents of the tool include instruction on how to specifically comply. Once completing the self-compliance tool, plan sponsors should retain the completed tool copy for their records. Should the DOL audit their plan, this document will be important.
In addition to the self-compliance tool document, plan sponsors should document how and why certain factors were considered and decisions made related to NQTLs and reimbursement rates. Consider using a benchmark plan to compare your plan. (Medicare is a great benchmark plan to compare your plan to).
- For additional information, see the news release.
- Also see, the Last Leavitt Group article on MHPAEA FAQs. This article has helpful guidance on a new disclosure notice and NQTL permissions.
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