MHPAEA Enforcement Is Here: What In-House Counsel Should Do to Prepare

The federal regulatory regime is extremely complex and federal and judicial interpretation of key issues remains unclear. In addition, MHPAEA’s narrow preemption language has led to surprising and extreme interpretations of employer and issuer obligations under state parity statutes that have led to significant equitable relief. Such relief has included new residential benefit mandates, wholesale reform of claims processing and prior-authorization procedures, claims review staff reorganizations and retraining, and the re-review of millions of dollars in claims denials.

Considering the uncertainty in federal audit and enforcement activity and the fact that every state has some form of unique parity-like statute, this area should now be a high priority for both employer and health plan issuer inside counsel.