December 3, 2014

Mental Health Parity Compliance Tools (article)

The Department of Labor's Employee Benefits Security Administration (EBSA) recently released two updated compliance tools to assist plan sponsors in making sure that their group health plans meet the requirements imposed by the federal mental health parity laws. 


As background, EBSA, together with the Departments of Treasury and Health and Human Services, issued final regulations a year ago to implement the requirements made by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA).  The MHPAEA expanded the mental health parity provisions enacted in 1996 by HIPAA.  The final rules took effect for plan years beginning on or after July 1, 2014 (see Reminder: Final Mental Health Parity Rules Become Effective July 1, Benefit Beat, 6/9/14). 


In a nutshell, these laws require mental health services, including substance use disorders, to be treated in a substantially similar manner to all covered medical and surgical services under a plan, including:

  • Cost-sharing requirements, such as deductibles, co-payments, coinsurance, and out-of-pocket expenses; and,
  • Treatment limitations, such as frequency of treatments, number of visits, days of coverage, or similar plan limits.

Generally, these mental health parity rules apply to:

  • Group health plans sponsored by employers employing 50 or more employees;
  • Grandfathered and non-grandfathered individual policies; and
  • Small non-grandfathered insured plans subject to the Affordable Care Act’s essential health benefit provisions. 

EBSA’s updated Self-Compliance Tool and Compliance Assistance Guide incorporate the final MHPAEA rules, both of which can be accessed from EBSA’s dedicated Mental Health Parity webpage

The information contained in this article is provided as general guidance and may be affected by changes in law or regulation. This article is not intended to replace or substitute for accounting or other professional advice. Please consult a CBIZ professional. This information is provided as-is with no warranties of any kind. CBIZ shall not be liable for any damages whatsoever in connection with its use and assumes no obligation to inform the reader of any changes in laws or other factors that could affect the information contained herein.

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