Compliance News | June 25, 2020
On June 19, 2020, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (the Departments) released a proposed updated version of their Mental Health Parity and Addiction Equity Act (MHPAEA) self-compliance tool.
The additions to the tool include:
The Departments intend to issue a final version of the 2020 self-compliance tool after considering comments from stakeholders, which must be submitted by email no later than July 24, 2020.
Numerous revised and additional examples are proposed in both the body and appendix of the tool. Some examples revisit issues addressed before but with greater specificity, such as:
Several examples provide new insights on the application of MHPAEA’s NQTL rules, such as:
In one example, the Departments indicate that if, for example, high cost is identified as a factor used in designing a prior authorization requirement, the threshold dollar amount at which prior authorization will be required for any service should also be identified, along with the data used to determine whether the benefit is high cost and how, if at all, the amount that is to be considered high cost is different for MH/SUD benefit as compared to medical/surgical benefits.
The tool references a recent court case and warns plan sponsors that if internal guidelines result in plan administration being more restrictive than the terms of the plan document, it may be a violation of Part 4 of ERISA (which includes ERISA’s fiduciary provisions). The tool warns plan sponsors to be prepared to disclose medical necessity criteria.
The tool suggests that a best practice is for plan sponsors is to develop an internal compliance plan that covers:
The examples and suggestions in the proposed tool highlight the Departments’ expectations that plan sponsors will be performing MHPAEA assessments and carefully monitoring and documenting their parity compliance.
Many plans rely on third-party administrators and utilization-management companies to administer medical management processes that are NQTLs under MHPAEA. Plan sponsors will need to work closely with administrators to ensure parity compliance is being achieved and documented.
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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