July 12, 2010

MHPAEA: Welcomed Non-enforcement Guidance

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), enacted on October 3, 2008, expanded the Mental Health Parity law, enacted in 1996.  Since the issuance of the interim final MHPAEA regulations earlier this year, many insurers have expressed concern about the practice of having two different payment standards for outpatient services, specifically, a co-pay, for example, for office visits, and a co-insurance for all other services. 

The DOL’s Employee Benefit Security Administration (EBSA) recently posted, on its website, an important non-enforcement guidance relating to the MHPAEA.  According to this guidance, for a limited time between now and the issuance of final regulations, the Agencies (DOL, IRS and HHS) have indicated that it will not enforce a violation of MHPAEA if a plan uses these sub-classifications, specifically for outpatient services.  Within the classification, a plan must satisfy the requirement that financial and treatment limits for mental health services cannot be more restrictive than “the predominant financial requirement or treatment limitation that applies to substantially all medical/surgical benefits in the sub-classification, using the methodology set forth in the interim final rules”.

This should provide some relief for plans struggling to comply with this aspect of the MHPAEA.


The information contained in this Benefit Beat is not intended to be legal, accounting, or other professional advice, nor are these comments directed to specific situations.

As required by U.S. Treasury rules, we inform you that, unless expressly stated otherwise, any U.S. federal tax advice contained in this Benefit Beat is not intended or written to be used, and cannot be used, by any person for the purpose of avoiding any penalties that may be imposed by the Internal Revenue Service.

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