Situation: Under the Federal Mental Health Parity and Addiction Equity Act of 2008, financial requirements and treatment limitations for mental health or substance use disorder benefits may not be more restrictive than those that apply to other medical and surgical benefits. The 2022 Report to Congress on the Paul Well Stone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 suggests that health plans and health insurers are failing to provide parity for mental health and substance use disorder benefits. Further, the Consolidated Appropriations Act of 2021 requires all group health plans and health insurers offering mental health and substance use disorder benefits and other medical benefits to perform and document a comparative analysis of the design and application of non-quantitative treatment limitations (NQTL). In 2022, the Department of Labor and the Department of Health and Human Services, through CMS, has alerted that they are stepping up enforcement.
- The parity law is important to assuring that individuals in need of mental health or substance use disorder treatment receive the necessary treatment.
- A determination of non-compliance by DOL would require the insurer to notify all enrolled individuals that coverage is noncompliant with the Mental Health Parity and Addiction Equity Act.
- Any relevant plans or insurers who are not in compliance with the Act could be sued by employees for failure to provide parity.
Solution: If you have done it yet, get your comparative analysis done now! Inquire with your TPA and/or benefits managers to see if the analysis has been done, but do not rely on them having done it. Some will not. At Offit Kurman, we have a team comprised of lawyers and a health insurance expert that can provide this needed service. The process includes review and analysis of plan document terms and Summary Plan Description as well as policies and collaboration with service providers. Any DOL audit will be extensive and will not only request the comparative analysis but also other specific supporting documentation. The best practice is to get your analysis complete and supporting documentation in order. Further plan to at least annually review and update your analysis and supporting documentation.
ABOUT MAGGIE DICOSTANZO
firstname.lastname@example.org | 717.980.3142
Maggie DiCostanzo is a principal attorney in Offit Kurman’s Healthcare practice group. For nearly 20 years she has focused her legal practice by representing physicians, hospitals, post-acute care facilities, and other healthcare professionals, delivering health law advice and counseling as well as representation in regulatory, general liability, and professional liability matters. She is also a registered patent attorney with the U.S. Patent & Trademark Office, and drafts licensing agreements and other intellectual property-related documents. Ms. DiCostanzo also assists lawyers in Offit Kurman’s other practice groups, including Business Law and Transactions, to address discreet healthcare issues.
ABOUT OFFIT KURMAN
Offit Kurman, one of the fastest-growing, full-service law firms in the United States, serves dynamic businesses, individuals and families. With 17 offices and nearly 250 lawyers who counsel clients across more than 30 areas of practice, Offit Kurman helps maximize and protect business value and personal wealth by providing innovative and entrepreneurial counsel that focuses on clients’ business objectives, interests and goals. The firm is distinguished by the quality, breadth and global reach of its legal services and a unique operational structure that encourages a culture of collaboration. For more information, visit www.offitkurman.com.
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