March 31, 2020
EBSA released a report of its efforts and CMS’ efforts to enforce the MHPAEA during fiscal year 2019. During that year, EBSA investigated and closed 186 health plan investigations, 183 of which involved plans subject to MHPAEA that were reviewed for compliance with the law. These investigations resulted in 12 citations for MHPAEA violations in 9 of those investigations.
As background, MHPAEA requires plans that provide coverage for mental health and substance use disorders to provide them in parity with medical/surgical benefits. The cost sharing and treatment limitations imposed on the mental health and substance use disorders coverage cannot be higher or more restrictive than the limitations imposed on the medical/surgical benefits.
Cases may stem from complaints submitted by participants who believe their mental health or substance use disorder benefits were denied. The agency’s benefits advisors may refer these complaints to investigators where the facts suggest that the problems are systemic and may adversely impact other participants and beneficiaries. In the report, EBSA stated that it investigated alleged violations of annual dollar limits, aggregate lifetime dollar limits, benefit classifications, financial requirements, treatment limitations and cumulative financial requirements. Generally, if violations are found by an EBSA investigator, the investigator requires the plan to remove any noncompliant plan provisions and pay any improperly denied benefits.
Employers should be aware of the EBSA’s efforts to make sure that benefit plans comply with the MHPAEA.
EBSA FY 2019 MHPAEA Enforcement Report »