Insights

Agencies Issue Final MHPAEA FAQ, Disclosure Form, and 2018 Enforcement Report


On September 5, 2019, the DOL, IRS, and HHS (the Departments) released a number of documents concerning mental health parity compliance, including a finalized FAQ. 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 finalizing FAQs About Mental Health and Substance Use Disorder Parity Implementation and the 21st Century Cures Act Part 39, the Departments also released a claims form that individuals can use to request documentation about their plan’s mental health treatment limitations, and three documents highlighting the DOL’s 2018 enforcement of MHPAEA. 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
This document provides additional guidance to employers and individuals about the application of the law. The finalized rules make slight changes to the proposed version by providing certain clarifications and adding additional examples. Here is an overview of the 11 questions addressed in this document:

  • Questions 1-8 address different nonquantitative treatment limitation issues, including experimental or investigative treatment limitations, prescription drug dosage limitations, step therapy and fail first policies, reimbursement rates for physicians and non-physicians, network adequacy, and medical appropriateness. One question also clarifies that plans can choose to exclude coverage for certain specific mental health conditions, as long as other federal or state laws don’t prohibit the exclusion.
  • Questions 9-11 discuss MHPAEA’s disclosure requirements. Specifically, the Departments discuss the model form that individuals can use to request plan information about their MH/SUD benefits. They also remind employers that they can provide a hyperlink or URL address where participants can access their provider directory, but that directory must be up-to-date and accurate so that participants can access correct information pertaining to MH/SUD providers.

FAQs 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.

Disclosure request form »
 

2018 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. This year, they included an introduction to the fact sheet and a compendium of guidance pertaining to the violations they found.

Notably, the DOL closed 115 cases involving a review of MHPAEA compliance, and 21 MHPAEA violations were cited in those cases. Additionally, the DOL’s benefits advisors addressed 127 public inquiries related to mental health parity.

2018 Fact Sheet »
2018 Fact Sheet Introduction »
Appendix: MHPAEA Violation Guidance Compendium »