January 24, 2017
In January 2017, the EBSA issued the FY 2016 MHPAEA Enforcement Fact Sheet. This fact sheet summarizes EBSA’s enforcement activities related to the Mental Health Parity and Addiction Equity Act (MHPAEA) over the 2016 fiscal year (FY).
As background, the MHPAEA requires employer-sponsored group health plans and health insurance issuers to ensure that financial requirements and treatment limitations applied to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.
The 2016 fact sheet outlines the main types of MPHAEA violations that resulted from the EBSA’s closed health investigations. The MPHAEA investigations primarily originated from participant complaints believing their MH/SUD benefits were incorrectly denied. As a result of the investigations, the main areas of MPHAEA noncompliance found include incorrect application of annual dollar limits, financial limits and qualitative treatment limitations (QTLs), and cumulative financial requirements. In addition, the fact sheet provides several examples of MHPAEA enforcement, which illustrate common areas of noncompliance and subsequent actions taken by EBSA Benefits Advisors to work with issuers to correct MPHAEA violations.
Given recent enforcement activity, employers should work with outside counsel on specific questions and plan designs, and also with their fully-insured carrier or ASO provider (if self-insured) to ensure MH/SUD benefits are compliant with all MHPAEA provisions.
FY 2016 MHPAEA Enforcement Fact Sheet »