The U.S. Department of Labor has collected its rules, guidance and other materials on the Mental Health Parity and Addiction Equity Act into a new MHPAEA Web page.
The materials on this page include a new set of frequently asked questions on “understanding implementation” of MHPAEA, which when enacted in 2008 substantially beefed up HIPAA’s original mental health parity provisions.
The FAQs just posted by DOL’s Employee Benefits Security Administration are generally not as technical as EBSA’s four previous rounds of FAQs, but they provide a concise source of background information on MHPAEA’s structure and scope.
EBSA did note that carve-out arrangements with managed behavioral health organizations are still allowed, as long as mental health and “substance use disorder” benefits are being “covered and managed in a manner that is no more stringent than medical/surgical benefits.” Group health plans, insurers and “other service providers should work together to ensure that standards for financial requirements, treatment limitations and non-quantitative treatment limitations are being met,” the agency added.
Another FAQ noted that fully insured plans remain subject to state mental health parity laws. “For example, while MHPAEA does not require that plans provide benefits for any particular mental health condition or substance use disorder, a State law may mandate that an issuer offer coverage for a particular condition,” according to the guidance. And conversely, any such coverage “must be in parity with medical/surgical benefits under MHPAEA.”
Health plans also may not define mental health coverage to comprise only inpatient care benefits, EBSA stated, assuming they offer medical/surgical benefits on an outpatient basis. The interim final MHPAEA rules, issued in February 2010 by DOL and the U.S. Departments of Health and Human Services and the Treasury, classify benefits into six categories — some inpatient, some outpatient.
Not only is parity required within each category, but “if a plan covers mental health or substance use disorder benefits in one of the six classifications, the plan must provide coverage in all of the classifications in which medical/surgical benefits are available,” EBSA explained.
MHPAEA requires parity in all financial requirements and treatment limitations. The 2010 interim rules imposed a detailed numerical formula for determining whether quantitative limits such as copayments and deductibles meet the act’s standards for parity.
The MHPAEA requirements are detailed in full in Thompson’s Employer’s Guide to HIPAA.