Mental Health Parity and Addiction Equity Act
I am pleased to offer expert advice to employers, administrators and third party administrators in untangling some of the difficult questions arising from the requirements mandated by the MHPAEA, particularly how it interacts with other federal mandates. These include:
- The Patient Protection and Affordable Care Act of 2010 (PPACA, commonly referred to as the Affordable Care Act (ACA));
- COBRA continuation health coverage;
- The Health Insurance Portability and Accountability Act of 1996 (HIPAA), i.e., privacy mandates.
My practice encompasses the following areas of expertise:
Auditing MHPAEA documentation and operational procedures
This review is performed in order to ensure that the health and welfare plan document contains MHPAEA provisions and complies with the requirements of the Act. This is extremely important given increased Department of Labor scrutiny and the significant Supreme Court decision in CIGNA Corp. v Amara (131 S. Ct. 1866 (2011)). The decision is a complex one, but in brief the Court found that the provisions of the summary plan description (SPD) and other disclosures cannot be enforced as the terms of the plan. Therefore, sponsors and administrators should review plans and any plan summaries and consider whether and to what extent they should draft formal welfare plan documents rather than rely upon insurance policies or summary booklets that describe benefits.
Training and education
This is particularly important in succession planning and maintaining continuity in benefits administration as key positions become vacant on account of retirements. The MHPAEA contains strict disclosure requirements. For example, it requires that plans make certain information available with respect to mental health or substance use disorder MH/SUD benefits including the criteria for medical necessity determinations with respect to MH/SUD benefits. This information must be made available to any current or potential participant, beneficiary, or contracting provider upon request.
Assisting in resolving day-to-day issues
I am a certified mediator and arbitrator, and regularly assist in the resolution of benefit disputes, including the MHPAEA. Typically, disputes involve financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits).
Looking to the Future
It is unknown what type of audits or reviews the Departments of Labor and Health and Human Services will undertake in enforcing the myriad of requirements under the MHPAEA. However, based on past experience it is certain that the most severe penalties will be borne by those employers that do nothing in order to meet their legal obligations under the law. Employers that can demonstrate a good faith effort to comply are likely to be treated much less harshly by these regulatory agencies (or a court) if a shortcoming is discovered or a complaint filed.