Federal Agencies Finalize Resources for Mental Health Parity Compliance

The Departments of Labor (DOL), Health and Human Services and the Treasury Departments have finalized resources to promote compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA).

These resources include:

  • Final FAQs on mental health parity;
  • A final model form that plan participants may use to request information about their mental health (MH) and substance use disorder (SUD) benefits.

The Departments also maintain a self-compliance tool and have identified warning signs of potential MHPAEA violations.

What is the Mental Health Parity and Addiction Equity Act?

MHPAEA is a federal law that generally prevents group health plans and health insurance issuers that provide mental health (MH) and substance use disorder (SUD) benefits from imposing less favorable limitations on those benefits than on medical and surgical coverage.

Employers, It’s Time to Take Action

Employers should consider using the aforementioned available resources and start workingwith their issuers and benefit administrators to confirm that their health plan’s coverage of MH/SUD benefits complies with the MHPAEA, including any non-quantitative treatment limitations (NQTLs).

  • Under the MHPAEA, requirements such as coinsurance, copays and treatment limitations (visit limits), applicable to MH/SUD benefits cannot be more restrictive than the requirements or limitations applied to substantially all medical and surgical benefits in that classification.
  • An NQTL is generally a limitation on the scope or duration of benefits for treatment. NQTLs include medical management standards, formulary designs for prescription drugs, plan methods for determining usual, customary and reasonable charges, etc..

In addition, MHPAEA requires group health plans and issuers to disclose certain information to plan participants about the plan’s coverage of MH/SUD benefits. If this information is requested, health plan sponsors should respond within 30 calendar days to avoid any possible penalties under the Employment Retirement Income Security Act (ERISA).

For more information regarding MHPAEA compliance, visit the Department of Labor’s website.

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Questions? Contact the Creative Benefits Team at 866-306-0200 or email us at solutions@creativebenefitsinc.com.