Is Your Mental Health Parity Compliance Up to Par?


Michelle Capezza, Member of the Firm in the Employee Benefits and Health Care and Life Sciences practices, in the firm’s New York office, authored an article in Law360, titled “Is Your Mental Health Parity Compliance Up to Par?”

Following is an excerpt (see below to download the full version in PDF format):

Compliance with the requirements of the Mental Health Parity and Addiction Equity Act of 2008, or MHPAEA, is an enforcement priority for the U.S. Department of Labor in 2018 and should be on the radar of group health plan sponsors. With certain exceptions, the MHPAEA requires that “large employer” group health plans (and health insurance issuers) that provide mental health or substance use disorder (MH/SUD) benefits do not impose less favorable conditions or more stringent limits on those benefits than they do on the same classification of medical and surgical benefits. The MHPAEA does not require a plan to cover any specific MH/SUD, but if it does cover such a condition, then it must be covered in parity with the medical and surgical benefits. Thus, there must be parity in financial requirements, quantitative treatment limitations, or QTLs, and nonquantitative treatment limitations, or NQTLs. Further, while the MHPAEA allows aggregate lifetime and annual dollar limits on MH/SUD benefits that meet the parity requirements, such dollar limits for MH/SUD benefits that are covered as essential health benefits are prohibited. Assessment of parity factors is complex, and the guidance regarding these issues is piecemeal.