Regulatory Resources
FAQs on Mental Health and Substance Use Disorder Parity Implementation:
On April 2, 2021, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury released guidance on implementation of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as amended by the No Surprises Act (Section 203) included in the Consolidated Appropriations Act.
Section 203 established new reporting and oversight requirements related to mental health and substance use disorder parity compliance of non-quantitative treatment limitations (NQTLs). In addition to codifying the comparative analysis approach included in the DOL’s 2020 MHPAEA Self Compliance Tool, the Act included processes for corrective action, a report to Congress on the findings of the federal reviews, and information sharing with states on compliance review findings.
Specific information addressed in the FAQs:
- Plans and issuers that offer both medical/surgical benefits and MH/SUD benefits and impose NQTLs must make their comparative analyses of the design and application of NQTLs available to the Departments or applicable State authorities upon request, beginning 45 days after the date of enactment (i.e., February 10, 2021)
- Plans and issuers that have carefully applied the guidance in the Self-Compliance Tool “should be in a strong position” to submit comparative analyses upon request.
The FAQs provide additional guidance on complying with the new comparative analysis documentation requirements, including the type of information plans and issuers must make available to regulators as well as the specific NQTLs the Departments expect to focus their enforcement on in the near term.
The U.S. Department of Labor’s Employee Benefits Security Administration has released an updated tool designed to help improve compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) and related requirements under ERISA.
Released on Oct. 23, 2020, the updated tool helps group health plans, plan sponsors, plan administrators, health insurance issuers, and other parties determine if a group health plan or a health insurance issuer complies with provisions of both laws relating to mental health and substance-use disorder benefits. It includes additional examples of compliance and non-compliance.
The federal law sets minimum standards for group health plans and issuers with respect to parity requirements. 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 copays. Treatment limitations include quantitative and non-quantitative limits on the scope or duration of treatment, such as visit limits or prior authorization.
Luminare Health will share more information on this topic as the federal regulators provide more guidance.