Compliance News | March 30, 2020
Sponsors of group health plans need to be aware that enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA) continues to be a priority for the federal government. Recently released reports underscore that enforcing compliance with MHPAEA is an ongoing focus of both DOL and HHS.
Undergoing a federal audit can be costly. Consequently, it’s a good idea to review your mental health and substance use disorder (MH/SUD) coverage for compliance with MHPAEA on a regular basis. Such reviews can help you identify and address issues that could come up in an audit. They can also help ease the burden if you face an audit.
DOL’s FY 2019 MHPAEA Enforcement Fact Sheet includes information about the enforcement activities of both DOL and HHS (specifically CMS). These are the highlights:
The Fact Sheet includes examples of enforcement findings, such as these:
DOL’s biennial report 2020 Report to Congress: Parity Partnerships: Working Together describes the department’s enforcement approach. DOL is continuing to shift its enforcement posture to target investigations that have a national impact for the greatest number of health plan participants and beneficiaries. The Report explains that DOL pursues investigations based on leads from other enforcement agencies, feedback from consumer groups, and implementation of advanced case development methods that incorporate various sources.
The report also describes new DOL activity to advance compliance with MHPAEA. To “empower the regulated community to fulfill its obligations under the law,” DOL will develop a roadmap for compliance. This year, it will host a listening session to gather stakeholder feedback.
In addition, DOL has developed a Five-Point MH/SUD Enforcement Evaluation Program. The elements of the program are:
As noted above, it’s a good idea to regularly review your plan for compliance with MHPAEA.
If you use service providers, consider coordinating with them to ensure they are administering your plan benefits to comply with MHPAEA.
On all issues involving the interpretation or application of laws and regulations, plan sponsors should rely on their legal counsel for legal advice.
This page is for informational purposes only and does not constitute legal, tax or investment advice. You are encouraged to discuss the issues raised here with your legal, tax and other advisors before determining how the issues apply to your specific situations.
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