Checklist to Make Sure Your Health Plan Complies With MHPAEA

As awareness rises and stigma decreases, society is focusing on the urgency and importance of treating mental health conditions and substance use disorders. Does your employer-sponsored health plan comply with the Mental Health Parity and Addiction Equity Act (MHPAEA)?

Checklist to Make Sure Your Health Plan Complies With MHPAEA

DOL Enforces Mental Health Parity Rules

The U.S. Department of Labor (DOL) considers this issue so important it has made mental health parity and addiction equity in health plan coverage one of its national enforcement projects. The 21st Century Cures Act of 2016 specifically requires the DOL to take additional steps to ensure that group health plans comply with mental health and substance use disorder rules. One of the main rules regarding mental health and substance use disorders is the Mental Health Parity and Addiction Equity Act (MPHAEA).

DOL Self-Compliance Checklist

Evidence, Insight and Strategy for Optimizing Health Benefits

To assist group health plans in following MHPAEA correctly, the DOL published a self-compliance tool for MHPAEA. It contains a detailed checklist for helping determine whether an employer-sponsored health plan complies with MHPAEA.

The DOL self-compliance tool addresses MHPAEA requirements regarding:

  • Applicability
  • Coverage in all classifications
  • Lifetime and annual limits
  • Financial requirements and quantitative treatment limitations
  • Cumulative financial requirements and treatment limitations
  • Nonquantitative treatment limitations (NQTLs)
  • Disclosure requirements.

NQTL Parity

One of the more confusing aspects of compliance is NQTL parity. An NQTL is a limitation on the scope or duration of benefits for treatment of a medical condition.

Some examples of NQTLs include:

  • Prior authorization or ongoing authorization requirements
  • Formulary design for prescription drugs
  • Standards for provider admission to participate in a network (including reimbursement rates)
  • Standards for providing access to out-of-network providers.

Section F of the DOL self-compliance tool (pp. 12–20) contains a more comprehensive list of NQTL examples and detailed compliance tips.

[Upcoming Webcast: Workplace 2020: Mental Health as a Strategic Asset | May 21, 2019]

Summary

Access to and affordability of treatment for mental health and substance use disorders is important. Employer-sponsored health plans that offer treatment benefits for mental health and substance use must comply with MHPAEA, and the federal government is enforcing compliance now more than ever. Employer-sponsored health plans can use the DOL Self-Compliance for MHPAEA guide to make sure they are doing everything they should.

Lois Gleason, CEBS
Lois Gleason, CEBS
E-Learning/Online Course Instructional Designer at the International Foundation

CEBS

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