Mental Health Parity Compliance Overview & FAQs
September 27, 2022
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires parity between a group health plan’s medical and surgical benefits and its mental health or substance use disorder (MH/SUD)benefits. In general, if a health plan provides MH/SUD benefits, MHPAEA requires the plan to:
- Offer the same access to care and patient costs for MH/SUD benefits as those that apply to medical/surgical benefits;
- Treat MH/SUD coverage and medical/surgical coverage equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review; and
- Contain a single combined deductible for MH/SUD coverage and medical/surgical coverage.
Parity Requirements
The financial requirements applicable to MH/SUD benefits can be no more restrictive than the predominant financial requirements applied to substantially all medical and surgical benefits. A plan’s treatment limits for MH/SUD benefits must also comply with MHPAEA’s parity requirements.
Aggregate lifetime and dollar limits must be the same.
Action Items
Talk with your Cottingham & Butler service team to help you understand:
- Your TPA/PBM’s role in assisting your plan meet its mental health parity obligations.
- Risks associated with your current plan design.
- Potential consequences for failure to comply.
MHPAEA – General Compliance FAQs is a brief FAQ about how self-funded plans can maintain compliance and be prepared in the event of a Department of Labor (DOL) audit.
