Enter to open, tab to navigate, enter to select
DOL Issues FAQs on Mental Health Parity and Addiction Equity Act
Practical Law Legal Update 1-519-3823 (Approx. 4 pages)
DOL Issues FAQs on Mental Health Parity and Addiction Equity Act
by PLC Employee Benefits & Executive Compensation
| Published on 10 May 2012 • USA (National/Federal) |
The Department of Labor (DOL) recently issued frequently asked questions (FAQs) on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Among other things, the FAQs address which types of benefits are subject to the MHPAEA and how the MHPAEA interacts with state law.
The DOL recently posted frequently asked questions (FAQs) addressing group health plan compliance with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The MHPAEA, which expands the Mental Health Parity Act of 1996 (MHPA), requires group health plans and health insurers that offer mental health or substance use disorder benefits to maintain parity between those benefits and the medical and surgical benefits they offer. The FAQs appear on a new DOL webpage that:
- Addresses compliance with mental health parity requirements.
- Provides related guidance and a self-compliance tool that:
- helps employers and plan administrators assess whether they are satisfying requirements for group health plans under the Employee Retirement Income Security Act (ERISA); and
- includes a series of compliance questions involving MHPA and MHPAEA requirements.
The FAQs, which address various aspects of MHPAEA compliance, explain that:
- The DOL and the Treasury Department enforce the MHPAEA's requirements for private, employer-sponsored group health plans. Individual states primarily enforce the MHPAEA's requirements for health insurers, although HHS may enforce the MHPAEA directly if it finds that a state has failed to substantially enforce the law. HHS also has direct enforcement authority over non-federal governmental plans.
- If a plan covers mental health or substance abuse disorder benefits in one of the six classifications set forth in interim final regulations issued in February 2010, the plan must provide coverage in all of the classifications in which medical and surgical benefits are available. For example, a plan that provides medical benefits on an outpatient basis (one of the six classifications) cannot limit mental health or substance use disorder benefits to inpatient care only (another of the classifications).
- A plan does not violate the MHPAEA by using a separate managed behavioral health organization for utilization review and other services involving mental health and substance use disorder benefits. The FAQs note that:
- the MHPAEA does not require insurance arrangements to be organized in any particular way; and
- managed behavioral health organizations may have specialized expertise in treating mental health and substance use disorders and in organizing specialty provider networks.
- States may impose stricter mental health requirements on health insurers. If state law requires an insurer to provide some coverage for any mental health condition or substance abuse disorder, the MHPAEA requires benefits for that condition to be in parity with medical and surgical benefits.
- Some plans are not subject to the MHPAEA, including retiree-only plans and employers with fewer than 51 employees.
The FAQs also note that the DOL, HHS and the Treasury Department coordinate with state regulators to promote MHPAEA compliance.
Practical Implications
These latest FAQs follow another set of FAQs on the MHPAEA issued less than six months ago (see Legal Update, DOL Issues FAQs on the ACA and the Mental Health Parity Requirements). Together with the new webpage on mental health parity compliance, the FAQs may signal greater enforcement efforts in this area. Although the DOL emphasizes that its intent is to provide MHPAEA compliance assistance for plans and insurers, one of the new FAQs contains contact information, including phone numbers and web addresses for the DOL, HHS and state departments of insurance, for use by individuals who believe their plan is violating the MHPAEA.