The Department of Labor’s Employee Benefits Security Administration is celebrating Mental Health Awareness Month this May by adding a new Mental Health Parity webpage to its website resources, which is available here.
EBSA also has released a new resource titled “Understanding (and Common Misunderstandings Related to Implementation of the Mental Health Parity and Addiction Equity Act of 2008”(Publication) available here.
The new Publication highlights information about the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
The MHPAEA generally requires employment-based group health plans and health insurance issuers that provide group health coverage for mental health/substance use disorders to maintain parity between such benefits and their medical/surgical benefits.
Specifically, MHPAEA and its implementing regulations generally:
- Provide that financial requirements (such as copays and deductibles), and quantitative treatment limitations (such as visit limits), applicable to mental health or substance use disorder benefits can generally be no more restrictive than the requirements or limitations applied to medical/surgical benefits;
- Include requirements to provide for parity for nonquantitative treatment limitations (such as medical management standards);
- Expand the parity requirements of an earlier law, the Mental Health Parity Act of 1996, such that plans and issuers may not impose a lifetime or annual dollar limit on mental health or substance use disorder benefits that is lower than the lifetime or annual dollar limit imposed on medical/surgical benefits.
The new Publication addresses various questions about the MHPAEA such as:
- If a health plan may define mental health coverage as consisting solely of inpatient care benefits;
- Whether the MHPAEA prohibits health plans from using separate managed behavioral health organizations to provide utilization review and other services with respect to mental health and/or substance abuse benefits (sometimes called a carve-out arrangements);
- How quantitative and nonquantitative treatment limitations on mental health benefits are analyzed under the MHPAEA;
- How the MHPAEA interacts with State mandates;
- What plans are exempt from MHPAEA;
- What participants and beneficiaries can do if they believe their group health plan is violating MHPEA; and
- What the Departments of Treasury, Health & Human Services and Labor are doing to promote compliance.
In addition to the federal mental health parity mandates under the MHPAEA, group health plans also are subject to mental health coverage mandates as part of the “essential benefits” requirements of the Affordable Care Act. Health plans, their sponsors, adminstrators and fiduciaries should review their health plan provisions to confirm compliance with these current mental health mandates.
For Help or More Information
If you need help preparing to comply with the mental health parity requirements or other help with reviewing and updating, administering or defending your group health or other employee benefit, human resources, insurance, health care matters or related documents or practices, please contact the author of this update, Cynthia Marcotte Stamer.
A Fellow in the American College of Employee Benefit Council, immediate past Chair of the American Bar Association (ABA) RPTE Employee Benefits & Other Compensation Group and current Co-Chair of its Welfare Benefit Committee, Vice-Chair of the ABA TIPS Employee Benefits Committee, a council member of the ABA Joint Committee on Employee Benefits, and past Chair of the ABA Health Law Section Managed Care & Insurance Interest Group, Ms. Stamer is recognized, internationally, nationally and locally for her more than 24 years of work, advocacy, education and publications on cutting edge health and managed care, employee benefit, human resources and related workforce, insurance and financial services, and health care matters.
A board certified labor and employment attorney widely known for her extensive and creative knowledge and experienced with these and other employment, employee benefit and compensation matters, Ms. Stamer continuously advises and assists employers, employee benefit plans, their sponsoring employers, fiduciaries, insurers, administrators, service providers, insurers and others to monitor and respond to evolving legal and operational requirements and to design, administer, document and defend medical and other welfare benefit, qualified and non-qualified deferred compensation and retirement, severance and other employee benefit, compensation, and human resources, management and other programs and practices tailored to the client’s human resources, employee benefits or other management goals. A primary drafter of the Bolivian Social Security pension privatization law, Ms. Stamer also works extensively with management, service provider and other clients to monitor legislative and regulatory developments and to deal with Congressional and state legislators, regulators, and enforcement officials concerning regulatory, investigatory or enforcement concerns.
Recognized in Who’s Who In American Professionals and both an American Bar Association (ABA) and a State Bar of Texas Fellow, Ms. Stamer serves on the Editorial Advisory Board of Employee Benefits News, the editor and publisher of Solutions Law Press HR & Benefits Update and other Solutions Law Press Publications, and active in a multitude of other employee benefits, human resources and other professional and civic organizations. She also is a widely published author and highly regarded speaker on these matters. Her insights on these and other matters appear in the Bureau of National Affairs, Spencer Publications, the Wall Street Journal, the Dallas Business Journal, the Houston Business Journal, Modern Health Care and many other national and local publications. You can learn more about Ms. Stamer and her experience, review some of her other training, speaking, publications and other resources, and register to receive future updates about developments on these and other concerns from Ms. Stamer here.
If you found this update of interest, you also may be interested in reviewing some of the other updates and publications authored by Ms. Stamer available including:
- ERISA Advisory Opinion Addresses If Connecticut Group Health Plan Plan Is “Government Plan”
- Labor Department Annual Self-Insured Health Plan Report To Congress Released
- NLRB Challenges Mandatory Arbitration or
- Comment On IRS Proposals On Determing Health Plan Minimum Value By June 11
- EEOC Sues Wendy’s Franchisee For Disability Discrimination
- Brokerage Firm To Pay $630,000+ To Benefit Plans To Settle DOL Charges It Wrongfully Steered Clients To Investments
- Latest $100,000 HIPAA Resolution Agreement Nails Physician Group,
- DC Court Enjoins Implementation of NLRB Poster Rule
- Health Plans Should Act Quickly To Prepare Affordable Care Act Required Summary of Benefits & Communications & Update Other Health Plan Communications
- Health Plan BCBST To Pay $1.5 Million In 1st OCR Enforcement Action Prompted By HITECH Breach Report
- NLRB Report Shows Rise In Unfair Labor Practice Complaints & Formal Proceedings
- Sullivan University System to Pay $483,000 in Back Wages Overtime Violations Stemming From Worker Misclassifications
For important information concerning this communication click here. THE FOLLOWING DISCLAIMER IS INCLUDED TO COMPLY WITH AND IN RESPONSE TOU.S. TREASURY DEPARTMENT CIRCULAR 230 REGULATIONS. ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, OR (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN.
©2012 Cynthia Marcotte Stamer, P.C. All rights reserved.
[*] See 26 CFR 54.9815-2715, 29 CFR 2590.715-2715, and 45 CFR 147.200, published February 14, 2012 at 77 FR 8668.
[†] See FAQS About Affordable Care Act
Implementation (Part VIII) at http://www.dol.gov/ebsa/pdf/faq-aca8.pdf.