Updates to Mental Health Parity Rules (article)
The federal mental health parity laws (the Mental Health Parity Act (MHPA), as amended by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA)), require mental health services to be treated in a substantially similar manner to all covered medical and surgical services under a health 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.
The 21st Century Cures Act, enacted on December 13, 2016, amended several provisions of the mental health parity laws (see the Mental Health Parity discussion in Benefit Implications Contained in New Law, Benefit Beat, 1/10/17). Specifically, the Cures Act requires additional information disclosures and non-quantitative treatment limitation standards. Further, the Cures Act requires treatment of eating disorder benefits under a plan to be provided in accordance with the mental health parity rules.
On June 16, 2017, the tri-governing agencies (Departments of Labor, HHS and Treasury) released an FAQ clarifying the changes made by the Cures Act. In particular:
- The guidance affirms that an eating disorder is considered a mental health condition and such treatment of an eating disorder must be covered in accordance with the mental health parity rules.
- The guidance explains an additional disclosure tool that covered individuals or their authorized representatives can use when seeking information about plan coverage, or to solicit information from the plan following an adverse determination of their mental health or substance abuse benefits to support an appeal. At the same time, the tri-governing agencies released a draft notice that can used for this purpose. It is not mandatory that individuals use a notice of this nature, but it will certainly give individuals or their representatives a means in which to solicit benefit information. Group health plan sponsors and administrators should begin to review the contents of this draft notice. Once this guidance is finalized, a request for this type of information must be provided to the individual requesting the information within 30 days of receipt. Failure to respond to the request could result in penalties of up to $110 per day.
The tri-governing agencies are soliciting public comments on both the eating disorder mandate and the disclosure notice through September 13, 2017.
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.