Mental Health Parity Guidance for Health Plans

By: Sherry Porter

The Department of Labor, Department of Treasury and Department of Health and Human Services (the “Departments”) issued 536 pages of guidance last week to help plan sponsors comply with the nonquantitative treatment limitations (NQTLs) rules under the Mental Health Parity and Addiction Equity Act (MHPAEA). The main goal of MHPAEA is to ensure that plan participants have similar access under their health plan to mental health benefits as they do to medical/surgical benefits. 

It has been well publicized that mental health issues skyrocketed during COVID-19. The MPHAEA has been around since 2008 and was initially intended to require group health plans that provide medical/surgical benefits as well as mental health or substance use disorder benefits to provide “parity” between those categories of benefits.  Plans must provide “parity” between the categories of benefits including quantitative limitations (such as financial requirements, copays or number of visits) and nonquantitative limitations (such as medical management requirements and step therapy protocols) such that the benefit limitations imposed on mental health/substance use benefits could not be more restrictive than limitations for the medical/surgical benefits.

The DOL has taken mental health parity very seriously in its enforcement duties and an employer that sponsors a group health plan that covers any mental health or substance use disorder benefits may find itself under a microscope to show that its plan complies with the MHPAEA.  While that all sounds fairly easy, actual compliance is not all that easy because it is not just a simple as straight comparison of benefits.  The DOL has provided guidance on this topic and its website contains a compliance tool. But given all the different plan designs, there really is no one way to show that a plan complies with the MHPAEA.

One of the most confusing concepts involves the nonquantitative treatment limitations rules. Under these rules, the group health plan (as written and in operation) must provide comparable benefits to mental health/substance use disorder benefits as it does to medical/surgical benefits.  The analysis looks at all factors, processes, strategies, and standards that would be used in applying limitations to benefits – separate treatment limitations for only mental health or substance use disorder benefits are not allowed.  The Consolidated Appropriations Act of 2021 requires health plans and insurers to perform and document a comparative analysis on any plan NQTLs.  This is a complicated analysis.  So complicated that the Departments issued 536 pages of guidance to assist plan sponsors and issuers (insurance companies) with MHPAEA compliance. 

More to come on this issue as we digest the guidance.  But rest assured, this will not be an easy process to ensure compliance with the law. Plan sponsors that have questions about this new guidance are encouraged to get in touch with a member of the Wyatt Labor and Employment practice group.

Sherry P. Porter

Sherry Porter has more than twenty years of experience in the employee benefits field.  She began her legal career as an investigator for the U.S. Department of Labor Employee Benefits Security Administration, where she conducted investigations to ensure compliance with ERISA and related laws and negotiated compliance agreements to correct violations.  Ms. Porter regularly advises clients on legislation affecting employee benefit plans, such as HIPAA privacy and security rules and the Patient Protection and... Read More