1.5 minute read
The Employee Benefits Security Administration (EBSA) has released its annual enforcement report on the Mental Health Parity and Addiction Equity Act (MHPAEA), highlighting its focus on ensuring equal benefits for mental health and substance use disorders.
MHPAEA ensures mental health and substance use disorder benefits are treated equally to medical benefits in group health plans. EBSA works to eliminate nonquantitative treatment limitations (NQTLs) that block parity for MH/SUD benefits.
EBSA dedicates 25% of its efforts to eliminating noncompliant limitations. However, future enforcement may be affected by budget constraints and a new presidential administration.
Mental Health Parity
MHPAEA mandates equal treatment for medical, surgical, and MH/SUD benefits in group health plans. This includes financial aspects like deductibles and copayments, quantitative treatment limits, and NQTLs affecting benefit scope. Health plans must analyze and share these comparisons with relevant authorities. These rules apply to large employers and, due to ACA reforms, also to small group market plans.
MHPAEA Enforcement
EBSA manages 2.6 million private-sector health plans, covering 136 million people. It investigates based on participant complaints and partners with states for MHPAEA enforcement. Over recent years, EBSA has reviewed numerous NQTLs, corrected MH/SUD treatment barriers for over 7.6 million participants, and ensured payment of wrongfully denied claims. When violations are found, EBSA mandates plan changes and notifications to affected parties. However, budget constraints limit its enforcement capacity to one investigator per 13,900 plans, and future enforcement priorities may shift with the new administration.
MHPAEA Compliance
To ensure MHPAEA compliance, employers should:
- Verify with issuers or administrators that a comparative analysis of NQTLs is complete;
- Be alert for problematic NQTLs like fail-first protocols; and
- Review parity requirements before altering medical and surgical benefits or MH/SUD benefits.
Download the bulletin for more details.
National Insurance Services is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Readers are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to the readers’ business activities.
