By David Slaughter, JD, Senior Legal Editor
Enforcement of mental health parity requirements is on the upswing, so plan sponsors and administrators need to be reexamining their plan documents and claims review processes for signs that mental health and substance use disorder (MH/SUD) benefits are being handled differently from other coverage.
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Investigators with the U.S. Department of Labor (DOL) have been instructed to “look under the hood” of group health plans, insurers, and third-party administrators (TPAs) to determine whether they’re complying with the Mental Health Parity and Addiction Equity Act (MHPAEA), according to Daniel Brice, an attorney with Bitman & King LLP in Syracuse, NY. “That’s a sea change,” he said in a recent webinar.
One driver is public concern about the opioid epidemic, with DOL recently clarifying that MHPAEA applies to medication-assisted treatment for opioid disorders. Mental health legislation pending in the Senate would also step up MHPAEA enforcement, and Democratic presidential nominee Hillary Clinton—who cosponsored MHPAEA as a senator—has outlined her own plans for doing so.
MHPAEA does not have its own detailed enforcement scheme, but noncompliant plans can be sued under the Employee Retirement Income Security Act (ERISA) by DOL or plan beneficiaries, Brice said. The Internal Revenue Service (IRS) also can impose excise taxes, though it has seldom done so to date.