The governmental agencies (DOL, HHS, and IRS) have proposed additional FAQs on mental health parity implementation, along with a revised participant disclosure form and other guidance. Under a federal law called the Mental Health Parity and Addiction Equity Act (MHPAEA), many health plans and insurers must make sure that there is “parity” between mental health and substance use disorder benefits, and medical and surgical benefits. This generally means that treatment limits applied to mental health and substance use disorder benefits must be at least as generous as the treatment limits applied to medical and surgical benefits. In other words, treatment limits cannot be applied to mental health and substance use disorder benefits unless those limits are comparable to limits applied to medical and surgical benefits. The types of limits covered by parity protections include:
- Financial requirements – such as deductibles, copayments, coinsurance, and out-of pocket
limits; - Treatment limits– such as limits on the number of days or visits covered, or other limits
on the scope or duration of treatment (for example, being required to get prior
authorization to get treatment).
Employer and plan administrators can use the self-compliance tool for MHPAEA to determine whether their plans comply with these regulations. The Department of Labor (DOL) investigators also use this same checklist for compliance audits of MHPAEA.
Proposed FAQ’s: https://www.dol.gov/sites/default/files/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-39-proposed.pdf
Revised Disclosure Form: https://www.dol.gov/sites/default/files/ebsa/laws-and-regulations/laws/mental-health-parity/mhpaea-disclosure-template-draft-revised.pdf
Self-Compliance Tool for MHPAEA: https://www.dol.gov/sites/default/files/ebsa/about-ebsa/our-activities/resource-center/publications/compliance-assistance-guide-appendix-a-mhpaea.pdf
