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Health Funds Can Anticipate Additional Guidance on Mental Health Parity


In the middle of December 2016, President Obama signed the 21st Century Cures Act into law. The Act contains two provisions relating to health care. The first provision deals with small employer HRAs. The second provision is a requirement that the DOL, HHS, and Treasury work together to develop additional guidance on the Mental Health Parity and Addiction Equity Act ("MHPAEA"). This additional guidance will be designed to help plans, patients and health care providers identify compliant and non-compliant plan designs. The guidance will focus on Non-Quantitative Treatment Limitations (NQTLs). NQTLs are particularly difficult from a compliance perspective due to their very nature of being non-quantitative. Pre-authorization requirements and the criteria for determining medical necessity are some examples of NQTLs. The guidance will provide illustrative examples and clarifying information. Plan sponsors will be anxious to review this additional guidance as current MHPAEA regulations are very unclear and failing to comply with even unclear regulations can result in large fines.


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