New Guidance for Complying with the Mental Health Parity and Addiction Equity Act

Just last month the Departments of Labor, Health and Human Services and Treasury (the “Departments”) issued Mental Health and Substance Use Disorder Parity Implementation FAQs Part 38 to provide additional guidance and clarification. The Mental Health and Addiction Equity Act (MHPAEA) was enacted in 2008. In short, MHPAEA requires parity between medical and surgical benefits and mental health and substance use disorder (MH/SUD) benefits. In practice this means that health plans are prevented from placing financial requirements and treatment limitations on MH/SUD benefits that are more restrictive than those placed on medical and surgical benefits. In FAQs Part 38, two disclosure requirements are addressed.

The Departments clarify that health plans must disclose the following information: 1) the criteria for medical necessity determinations involving MH/SUD benefits, and 2) the reason for denying reimbursement or payment for MH/SUD services. The Departments state that the information regarding medical necessity determinations must not only be provided to current participants and beneficiaries, but potential ones as well. In this latest guidance, the Departments also look at eating disorders and clarify that the term “mental health benefit” applies to such disorders.

For more information, FAQ Part 38 can be accessed here: https://www.dol.gov/sites/default/files/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-38.pdf