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Federal Agencies Issue Additional Guidance and Signal Stepped-Up Enforcement of Mental Health Parity Rules

Labor & Employment Regulatory Newsletter John Barlament

ISSUE: In April 2018, the Department of Labor ("DOL"), Department of Health and Human Services ("HHS"), and the Internal Revenue Service (collectively, the "Agencies") issued a package of resources relating to compliance with the Mental Health Parity and Addiction Equity Act of 2008 ("MHPAEA"). The MHPAEA is a federal law requiring group health plans and health insurers that offer mental health and substance use disorder benefits to make the treatment limitations and financial requirements for such benefits no more restrictive than those applied to medical and surgical benefits offered under the plan. It generally applies to employers with 50 or more employees.

The Agencies' April 2018 compliance package included the following:

  • proposed FAQ guidance providing clarifications regarding non-quantitative treatment limitations (e.g., restrictions based on facility type) and ERISA disclosures;
  • self-compliance tool for plan sponsors and carriers;
  • draft MHPAEA disclosure template that plan participants can use to request documentation from a health plan or insurer regarding treatment limitations;
  • HHS Action Plan for Enhanced Enforcement of MHPAEA;
  • DOL Report to Congress summarizing the DOL's 2017 enforcement activities and its plan for future enforcement; and
  • MHPAEA 2017 Enforcement Fact Sheet.

Read more Insight & Impact from June 2018:

IMPACT: The new guidance offers a "roadmap" for plan participants (and their lawyers) to seek additional information from health plans. Many plans may not be prepared to provide the information which would be requested. Yet the plans would generally only have 30 days to provide what may be voluminous information. And the information goes beyond just providing a simple summary plan description -- it can include provider reimbursement rates and other details which are not normally requested by plan participants.

The Enforcement Fact Sheet disclosed that in 2017, the DOL closed 187 investigations involving health plans subject to the MHPAEA, of which 92 were found to have violated the MHPAEA. The HHS Action Plan and DOL Report also indicate that these agencies plan to increase investigations and enforcement activities related to MHPAEA compliance.

As such, plan sponsors, especially those with self-insured plans, should review their health plans in the context of the recent guidance and self-compliance tool to ensure that their plans do not violate MHPAEA rules.

For more information, please contact your local Quarles & Brady attorney or this member of our employee benefits group: