Hi, I’m Dan Kuperstein, and welcome to this episode of ComplianceMINUTE.
The Departments of Labor, Treasury, and Health and Human Services recently released FAQ guidance, a draft disclosure form, and a request for comments on, certain aspects of the Mental Health Parity and Addiction Equity Act (or “MHPAEA”) and the 21st Century Cures Act (or “Cures Act”).
To provide some background on this new guidance, The Cures Act, which was signed into law in December of 2016, required the Departments to take steps in 2017 to strengthen enforcement of the MHPAEA.
Additionally, the Cures Act required the Departments to solicit public feedback on how to improve the process participants can use to request information from a health plan about the plan’s compliance with the MHPAEA. The Cures Act also clarified that, if provided, coverage for eating disorders, including residential treatment, must be consistent with the MHPAEA.
The MHPAEA is a law that requires parity between medical or surgical benefits and mental health or substance use disorder benefits in the application of:
- Annual and lifetime dollar limits;
- Financial requirements (such as deductibles, copayments, coinsurance, and out-of-pocket maximums);
- Quantitative treatment limitations (such as number of treatments or visits, or days of coverage); and
- Non-quantitative treatment limitations (such as restrictions based on facility type or geographic location).
The new draft model form that was released by the Departments along with this guidance, is a form that participants, enrollees, and their authorized representatives can use to request information from their plan or insurer about non-quantitative treatment limitations.
The Departments requested comments on the draft form, as well as a variety of specific disclosure issues, including steps that could be taken by the Departments to simplify the process for requesting disclosures. Comments on the new guidance and the form are due by September 13, 2017.
So, what are the key takeaways here for plan sponsors? While the draft form and guidance are helpful, and certainly, they’ve been welcomed by employers, there is still a lot of confusion out there by both employers and insurers about how to comply with the mental health parity rules.
In a published statement by the American Benefits Council, the Council noted some of the complexities of mental health parity compliance and the difficulties that employers are facing. For example, the Council noted that the non-quantitative treatment limitation rule is a rule that continues to be a challenge for employers and health plans, particularly because of its vagueness and broad-reaching impact. Specifically, the Council noted that the Departments have not provided clear guidance on the rule’s parity analysis as it applies to limitations on benefits for autism and applied behavioral analysis therapy and residential treatment.
For more information on this and other ACA topics, visit our Knowledge Center at corpsyn.com. Thank you.