Benefits, Health Care Reform, Mental Health Parity & Addiction Equity Act

New Guidance on Mental Health Parity Act and Enhanced Enforcement

This week the Departments of Labor (DOL), Health and Human Services (HHS) and the IRS issued a package of  guidance on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). A list of the various guidance is below, with links to the documents and a short explanation of what each document is.

The FAQs Part 39 may be of most interest to employers.  These FAQs were issued because the 21st Century Cures Act (enacted December 13, 2016) requires the Departments to solicit feedback and issue clarifying information and illustrative examples regarding MHPAEA provisions on Non-quantitative Treatment Limitations (NQTLs) and on ERISA disclosure. As stated in prior MHPAEA regulations, parity requires that plans and insurers may not impose NQTLs on mental health/ substance use disorder (MH/SUD) benefits unless any methods, processes, strategies, evidentiary standards and other factors in applying the NQTLs are comparable to, and are applied no more stringently than, those used in applying the NQTL to medical/surgical benefits in the same classification.

Plan sponsors — especially those with self-insured plans — should review the FAQs and Self-Compliance Tool to make sure their plans do not include provisions that violate MHPAEA rules, particularly the plan provisions on Non-quantitative Treatment Limitations (NQTLs).

Background

The Mental Health Parity and Addiction Equity Act requires that IF a plan provides coverage of mental health/ substance use disorder (MH/SUD) benefits, such coverage must be on par with (i.e., at least as good as) coverage of medical/ surgical benefits in the same classification or category. There are six classifications of benefits:  1-Inpatient in-network; 2-Outpatient in-network; 3-Inpatient out-of-network; 4-Outpatient out-of-network; 5-Prescription drugs; and 6-Emergency care.

The mental health parity requirements apply to three different types of limitations that plans impose on benefits: 1- Financial requirements; 2- Quantitative treatment limitations (QTLs); and 3- Non-quantitative treatment limitations (NQTLs). The parity rules for financial limitations and QTLs are different from the rules for NQTLs.

The proposed FAQs issued April 23rd primarily address parity rules for NQTLs, as well as ERISA disclosure requirements. The Self-compliance Tool addresses all areas of the MHPAEA. See below.

The New Guidance

  • Updated (2018) MHPAEA Self-Compliance Tool. Plan sponsors (and carriers) can use to determine whether their plans comply with MHPAEA. EBSA investigators also use this same checklist. Covers whether a health plan is subject to MHPAEA, the six classifications of benefits, financial limitations, quantitative treatment limitations, non- quantitative treatment limitations, disclosure requirements.

 

 

 

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