Note: The following article is intended to provide comprehensive information about mental health parity compliance services. It is not intended to substitute professional medical advice. If you are seeking mental health services, please consult with a qualified healthcare provider.
Introduction
In recent years, there has been a growing recognition of the importance of mental health and substance use disorder (MHSUD) treatment. To ensure that individuals receive equitable access to mental health services, the Centers for Medicaid & Medicare Services (CMS) enacted the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008. This legislation builds upon the Mental Health Parity Act of 1996 and requires health insurers and group health plans to provide the same level of benefits for mental health and substance use treatment as they do for medical or surgical care.
Compliance with mental health parity laws is crucial for organizations to ensure fair and equal access to mental health services. In this article, we will explore the key aspects of mental health parity compliance services, including the regulations, enforcement efforts, and steps organizations can take to ensure compliance.
Summary of MHPAEA Protections
The Mental Health Parity Act of 1996 established that large group health plans cannot impose less favourable annual or lifetime dollar limits on mental health benefits compared to medical or surgical benefits. The MHPAEA of 2008 expanded on these protections and extended them to substance use disorders. While MHPAEA does not require group health plans to cover mental health and substance use disorder benefits, it mandates that if these benefits are included, they must be treated with parity in terms of financial requirements and treatment limitations.
Under MHPAEA, the financial requirements and treatment limitations for mental health and substance use disorder benefits must be no more restrictive than those imposed on medical or surgical benefits. This means that deductibles, co-payments, number of visits, and days of coverage for mental health and substance use disorder treatment should be comparable to those for medical or surgical care. Additionally, plans must provide out-of-network benefits for mental health and substance use disorder services if they offer out-of-network benefits for medical or surgical care.
Key Changes Made by MHPAEA
MHPAEA introduced several significant changes to ensure parity between mental health and substance use disorder benefits and medical or surgical benefits. These changes include:
- Substantially All/Predominant Test: If a group health plan or health insurance coverage includes both medical or surgical benefits and mental health or substance use disorder benefits, the financial requirements and treatment limitations for mental health or substance use disorder benefits must be no more restrictive than those for medical or surgical benefits. This test, known as the “substantially all/predominant test,” aims to achieve parity in benefit limitations.
- No Separate Cost-Sharing Requirements or Treatment Limitations: Mental health or substance use disorder benefits cannot be subject to separate cost-sharing requirements or treatment limitations that only apply to these benefits. This ensures that individuals do not face additional financial burdens or restrictions when seeking mental health or substance use disorder treatment.
- Out-of-Network Benefits: If a group health plan or health insurance coverage provides out-of-network benefits for medical or surgical care, it must also provide out-of-network benefits for mental health or substance use disorder services. This requirement ensures that individuals have access to a wide range of providers when seeking mental health or substance use disorder treatment.
- Disclosure of Medical Necessity Determinations: The MHPAEA regulations require that standards for medical necessity determinations and reasons for any denial of benefits related to mental health or substance use disorder benefits be disclosed upon request. This promotes transparency and allows individuals to understand the criteria used for coverage decisions.
MHPAEA Regulation
To enforce the provisions of MHPAEA, the CMS published a final regulation in November 2013. The regulation applies to non-Federal governmental plans with more than 50 employees, private employer group health plans with more than 50 employees, and individual health insurance coverage. It does not directly apply to small employer group health plans. However, the Affordable Care Act’s essential health benefit requirements indirectly apply MHPAEA standards to small group health plans.
The regulation outlines the substantially all/predominant test, which must be applied separately to six classifications of benefits: inpatient in-network, inpatient out-of-network, outpatient in-network, outpatient out-of-network, emergency, and prescription drug. It requires that all cumulative financial requirements, including deductibles and out-of-pocket limits, combine medical or surgical and mental health or substance use disorder benefits.
The regulation also addresses quantitative and nonquantitative treatment limitations (NQTLs). Quantitative treatment limitations include numerical restrictions, such as visit limits or day limits, while nonquantitative treatment limitations encompass factors like medical management or pre-authorization. Plans must ensure that any nonquantitative treatment limitations applied to mental health or substance use disorder benefits are comparable to those applied to medical or surgical benefits.
Compliance Enforcement and Recent Actions
Compliance with mental health parity laws is becoming increasingly important, and enforcement efforts are expected to increase over time. The U.S. Department of Labor (DOL), the Centers for Medicare and Medicaid Services (CMS), and the U.S. Department of the Treasury have taken several actions to ensure compliance with MHPAEA.
They have issued briefs summarizing their enforcement efforts and have provided technical releases outlining approaches to determining data requirements for addressing nonquantitative treatment limitations. These agencies have requested comments on these technical releases to gather input from stakeholders.
Moreover, there are discussions about updating the current 2013 final MHAEA regulations to introduce additional compliance measures. These potential updates may result in higher costs for employers, making it even more crucial to prioritize mental health parity compliance.
How Mental Health Parity Compliance Services Can Help
Navigating the complexities of mental health parity compliance can be challenging for organizations. That’s where mental health parity compliance services come into play. These services provide expertise and guidance to help organizations understand their obligations under MHPAEA and ensure that their benefits offerings are compliant.
Mental health parity compliance services can assist organizations in several ways:
- Determining Obligations: They can help organizations determine whether they are obligated to offer mental health and substance use disorder services as plan sponsors under MHPAEA. By assessing the organization’s size and plan offerings, they can provide clarity on compliance requirements.
- Assessing Compliance: Mental health parity compliance services can assess the current or prospective benefits offerings of an organization to ensure compliance with MHPAEA requirements. They can review financial requirements, treatment limitations, and other plan features to identify any potential disparities and recommend necessary adjustments.
- Certification of Compliance: These services can assist organizations in obtaining a certification of compliance for MHPAEA. This certification demonstrates that the organization has met the requirements of MHPAEA and is committed to providing equitable access to mental health and substance use disorder benefits.
- Incorporating Mental Health Parity into Corporate Compliance: Mental health parity compliance services can help organizations integrate mental health parity alignment into their existing corporate compliance policies and procedures. This ensures that mental health and substance use disorder benefits are given the same level of attention as medical or surgical benefits.
By leveraging the expertise and guidance of mental health parity compliance services, organizations can navigate the complexities of MHPAEA and ensure that they are providing equitable access to mental health and substance use disorder treatment.
Conclusion
Mental health parity compliance services play a crucial role in helping organizations meet the requirements of the Mental Health Parity and Addiction Equity Act. By ensuring equitable access to mental health and substance use disorder benefits, organizations can support the well-being of their employees and promote a healthier workforce.
Compliance with mental health parity laws is not only a legal obligation but also a moral imperative. Organizations that prioritize mental health parity compliance demonstrate their commitment to supporting the mental well-being of their employees and contribute to reducing the stigma surrounding mental health and substance use disorders.
If your organization is facing challenges related to mental health parity compliance, consider reaching out to a mental health parity compliance service provider. They can guide you through the compliance process, help you understand your obligations, and ensure that your benefits offerings align with the requirements of MHPAEA. By investing in mental health parity compliance, you are investing in the overall health and wellness of your organization and its employees.
