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Agencies Release FAQs on Mental Health Parity

On Behalf of | Jun 29, 2017 |

DOL, HHS and IRS have released FAQs about Affordable Care Act Implementation Part XXXVIII. Specifically, FAQs XXXVIII address whether certain requirements under the Mental Health Parity and Addiction Equity Act (“MHPAEA”) apply to benefits that a group health plan or health insurance issuer may offer for treatment of an eating disorder.

In addition, FAQs XXXVIII also provide access to a draft model disclosure form to be used by participants to request certain disclosures related to non-quantitative treatment limitations (“NQTLs”) under a group health plan or insurance policy.

Background. The MHPAEA, which was amended by the Affordable Care Act and 21st Century Cures Act, says that the financial requirements and treatment limitations applicable to a group health plan’s mental health and substance use benefits (“MH/SUD benefits”) cannot be more restrictive than the financial requirements and treatment limitations for other medical and surgical benefits.

The MHPAEA also requires a group health plan or issuer to disclose, upon request of a participant or beneficiary, the criteria for medical necessity determinations that apply to MH/SUD benefits.

FAQs XXXVIII. FAQs XXXVIII confirm that eating disorders are mental health conditions. Accordingly, treatment of an eating disorder is a mental health benefit within the meaning of that term under the MHPAEA. Therefore, a group health plan that imposes more restrictive financial requirements and treatment limitations on eating disorder treatments will violate the MHPAEA, which can result in significant liability for plan sponsors.

FAQs XXXVIII also include a link to a draft model form that participants, enrollees or their authorized representatives may use to request information from their health plan or issuer regarding NQTLs that may affect their MH/SUD benefits, or obtain information after an adverse benefit determination involving MH/SUD benefits to support an appeal.

FAQs XXXVIII are available at: