Departments Issue Mental Health Parity Guidance, Including Proposed FAQs

On April 23, 2018, the DOL, HHS and Treasury (the Departments) released a number of documents concerning mental health parity compliance, including proposed FAQs. As background, the Mental Health Parity and Addiction Equity Act (MHPAEA) requires that the financial requirements and treatment limitations imposed on mental health and substance use disorder (MH/SUD) benefits be no more restrictive than the predominant financial requirements and treatment limitations that apply to substantially all medical and surgical benefits. MHPAEA also imposes several disclosure requirements on group health plans and health insurance issuers.

In addition to releasing proposed FAQs About Mental Health and Substance Use Disorder Parity Implementation and the 21st Century Cures Act Part 39, the Departments also released a model Mental Health and Substance Use Disorder Parity Disclosure Request form, a MHPAEA self-compliance tool, the 2018 Report to Congress (entitled Pathway to Full Parity), the 2017 MHPAEA enforcement fact sheet and an action plan for enhanced enforcement. See below for a recap on each of those resources.

FAQs About Mental Health and Substance Use Disorder Parity Implementation and the 21st Century Cures Act Part 39
These FAQs provide additional guidance to employers and individuals about the application of the law. Here are some highlights of the 12 FAQs provided in this document:

  • FAQ 1 indicates that the Departments are releasing an updated draft model disclosure form, which individuals would use to request information pertaining to their plan’s mental health benefits. The draft form was updated after the Departments received a number of comments on the original draft (which was released in 2017). The Departments are also requesting comments on the updated form, which must be submitted by June 22, 2018.
  • FAQs 2-10 address different nonquantitative treatment limitation (NQTL) issues, including experimental limitations, prescription drug limitations, step therapy, reimbursement rates for physicians and non-physicians, network adequacy, medical appropriateness and emergency room care of acute conditions.
  • FAQs 11-12 discuss medical health provider directories and the requirement to provide participants with an up-to-date list of network providers. Employer plan sponsors are allowed to provide a link to the list as long as they comply with the DOL’s electronic disclosure safe harbor.

FAQ Part 39 »

Model Mental Health and Substance Use Disorder Parity Disclosure Request Form
The Departments provided this form as an example of a MHPAEA disclosure request form. Participants can use this form to request information from their employer-sponsored health plan or insurer regarding MH/SUD limitations or denials in benefits.

Request Form »

Self-Compliance Tool
This MHPAEA self-compliance tool is designed to assist employers in determining if their plan is compliant with MHPAEA’s requirements. The tool prompts employers to ask themselves a series of questions about mental health parity requirements and provides compliance tips along the way. This tool is similar to the DOL’s self-compliance tool for Title VII.

Self-Compliance Tool »

Pathway to Full Parity Report
This 2018 report to Congress outlines the various MHPAEA enforcement actions that were taken by the Departments in the last few years.

Pathway to Full Parity Report »

2017 MHPAEA Enforcement Fact Sheet
This fact sheet highlights the MHPAEA enforcement results pursued by the DOL. It specifically breaks down the number of cases concerning MHPAEA violations and discusses some of the results achieved through the DOL’s voluntary compliance program.

Notably, the DOL reviewed 187 plans for compliance with MHPAEA, and 92 of those plans were cited for violations of MHPAEA. Additionally, the DOL’s benefits advisors addressed 127 public inquiries related to mental health parity.

2017 Enforcement Fact Sheet »

Action Plan for Enhanced Enforcement
This report discusses the planned actions following the Departments’ public listening session (in July 2017) and the solicitation and receipt of comments on MHPAEA enforcement in 2017. It also discusses the Departments’ recent and planned actions to maintain momentum on parity enforcement.

Action Plan »