Are you in compliance with mental health parity?

While most of us have accepted the new normal created by the pandemic, the impact on the economy, and the closing of schools and business have left many Americans feeling stressed, lonely, depressed, and fearful—especially our children. According to the CDC’s pulse survey this fall, 11 million Americans said they needed mental health services but didn’t receive them. Clearly, there is a pressing need to expand this critical support for emotional welfare.

The December issue of Scientific American offered excellent insight. “COVID has already killed or disabled millions, deepened economic insecurity, and forced radical adaptations to daily life; its serious effects on mental health and well-being very likely will continue and in ways still unknown,” the editors wrote.

Congress has made the mental health crisis a priority. In December 2020, Congress took steps to overcome it with an amendment to the Mental Health Parity and Addiction Equity act (MHPAEA). The original law, enacted in 2008, made it illegal for medical benefit providers to treat mental health and substance use conditions differently from other medical conditions. The goal of the 2020 amendment: to ensure compliance by group health insurers and self-insurers.

The key point here is that employers that sponsor group benefit plans are responsible for compliance.

Here are some key facts employers need to know now:

  • Are all employers required to offer plans with mental health parity? For the most part, yes. There are some unusual exceptions like some government employee health plans and plans created and purchased prior to March 23, 2010.
  • Does federal or state law prevail? Some states have mental health parity laws. While the federal parity law establishes a minimum standard, if the the state law is stronger it carries the day.
  • What does parity look like in practice? There are three elements. (1) Annual or lifetime dollar limits – Any dollar limits you have on mental health/substance abuse must be the same or higher than limits on medical/surgical benefits. (2) Financial requirements and quantitative treatment limits – Deductibles, copays, coinsurance and out-of-pocket maximums must be equivalent. The same goes for number of appointments or inpatient days. (3) Non-quantitative treatments limits (NQTLs) – These are the processes, standards and other criteria used to determine whether or not benefits for treatment are approved, limited or denied.
  • Are employers required to do anything now? If your plan offers benefits for medical and surgical procedures as well as mental health and substance use disorders, there is administration to be done. As of February 10, 2021, you were required to ensure that your plan can produce a comparative analysis of NQTLs. The Department of Labor (DOL) has been investigating plans and is supposed to report noncompliance to Congress at the end of this year.

Now is a good time to check with your carrier or Third Party Administrator (TPA) and make sure they have performed a NQTL analysis. You should obtain a copy and review it. Also make sure you know how to respond to a DOL audit. Talk to a benefits advisor or a benefits attorney to make sure you have all of your bases covered.