By Bonnie Villa, Benefits Compliance Paralegal

What is MHPAEA?

The Mental Health Parity Act of 1996 (“MHPA”) mandated large group health plans (those with more than fifty employees) cannot impose annual or lifetime dollar limits on mental health benefits that are less favorable than limits imposed on medical/surgical benefits. The Mental Health Parity and Addiction Equity Act of 2008 (hereinafter “MHPAEA”) conserves MHPA protections and adds parity requirements to substance use disorders. MHPAEA requires group health care plans ensure financial requirements and treatment limitations on mental health or substance use disorder (MH/SUD) benefits are no more restrictive than medical or surgical (M/S) benefits. MHPAEA also sets minimum standards for group health plans and issuers on parity requirements. Further, the Consolidated Appropriations Act of 2021 (hereinafter “CAA”) amended MHPAEA requiring group health plans that offer both M/S and MH/SUD benefits to perform and document comparative analyses of Quantitative Treatment Limits (hereinafter “QTL”) or Non-Quantitative Treatment Limits (hereinafter “NQTL”) that apply to the plan.

To whom does this apply?

MHPAEA requires the vast majority of group health care plans, along with group and individual health insurance issuers to comply. If a plan offers any MH/SUD benefits, the plan will need to ensure that the treatment of all MH/SUD benefits are in parity with M/S benefits. Some states require plans to offer certain MH/SUD benefits, which means plans in those states will not have the option to exclude all MH/SUD benefits, meaning they are subject to MHPAEA.

Why Should I Comply?

The tri-agencies (Departments of Labor (“DOL”), Health & Human Services (“HHS”), and Treasury) are responsible for MHPAEA enforcement. In 2021, the Employee Benefits Security Administration (“EBSA”) investigated 148 healthcare plans with 74 plans subject to MHPAEA including 17 fully insured plans, 41 self-insured plans, and 16 plans that offered both fully insured and self-insured options. EBSA cited 14 MHPAEA violations in 12 of the investigations. In August 2021, United Healthcare settled at $15.6 million over MHPAEA violations. If the DOL deems your plan noncompliant, the plan must notify all individuals enrolled in the plan of this noncompliance with MHPAEA and participants can sue the plan sponsor under ERISA for violating MHPAEA. The Departments will also share findings of noncompliance with the State where the group health plan is located.

When is the Deadline?

Per a prior investigator with the DOL, once the DOL requests a comparative analysis from the plan sponsor, it is already too late. The CAA required group health plans and health insurance issuers to conduct comparative analysis and make available upon request by February 10, 2021. Upon review if the DOL, Health and Human Services, and Treasury found the plan out of compliance with MHPAEA, the plan would have 45 days for corrections. If the plan remained out of compliance, the plan was to notify all enrolled individuals of noncompliance within seven days.

The 2022 MHPAEA Report to Congress highlights recent emphasis on greater MHPAEA enforcement.

How do I comply?

Group health plans and health insurance carriers are required to perform comparative analyses to demonstrate compliance with mental health parity requirements and modify plans, as needed. These analyses include identification and classification of all treatment limitations within the plan documents and identification of treatment limitations in operation. Moreover, the analyses must establish parity by citing specific examples of treatment limitations and how treatment limitations are applied equally between M/S and MH/SUD benefits. These comparative analyses must be detailed and specific.

Where do I start?

CXC Solutions offers comparative analyses and remedies for plans not in compliance with MHPAEA. If your organization is seeking assistance, please contact us at info@cxcsolutions.com or go to Contact with us – CXC Solutions.