Under the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), employers that provide benefits for mental health or addiction care must ensure that their plan limitations cannot exceed those on medical or surgical care plans. In short, there must be parity between limitations on mental and physical healthcare plans. Employers must also comply with the Department of Labor (DOL) regulations under the act.
Based on WTW’s 600 mental health parity reviews over the last 24 months, we have found th ere are critical measures employers can take to ensure compliance with mental health parity regulations.
We advise employers to take the following steps:
01
Employers should familiarize themselves with the MHPAEA and other relevant regulations to ensure they understand their obligations. The DOL continues to focus heavily on oversight of nonquantitative treatment limitations (NQTLs), particularly those associated with prior authorization, concurrent review, network adequacy and provider reimbursement.
“Non-quantitative treatment limitations” (NQTLs) are anything that can limit the scope or duration of a benefit, such as prior authorization and utilization review. Examples include prior authorization, credentialling of providers and provider reimbursement, and network access. The application of a NQTL to mental health/substance use disorder benefits in a classification must be comparable to, and applied no more stringently than, those used in applying the limitation with respect to medical/surgical benefits in the same classification.
02
Employers should review their benefits packages and full design and coverage details to ensure they comply with the MHPAEA and offer mental health benefits that are comparable to medical and surgical benefits. The DOL has definitively focused on impermissible limitations in its’ latest report to congress, making awareness of existing and emerging treatment for MH/SUD conditions critical for employers to be aware of. More importantly, in situations where there are different vendors responsible for administering medical/surgical benefits and mental health benefits, employers can establish vendor governance programs to ensure comparable administrative processes related to development and application of NQTLs.
03
Employers should monitor ease of network access for employees who are seeking mental health services to ensure systems meet regulatory standards. The DOL focuses on reviewing vendor networks to ensure there are sufficient facilities and providers in a geography while monitoring access to providers who have available appointments. Further, the DOL has stressed that mental health provider directories must be current. Many employers are developing new strategies and implementing new solutions to improve mental health access, including expanded and redesigned employee assistance programs, expanded access to virtual care, and no-share of cost benefits for mental health services.
04
As part of a benefits strategy, employers should involve their staffs, including human resources and employee resource groups (ERGs), benefit administrators and claims processors, to ensure that compliance with MHPAEA is a part of their organizations’ overarching mental health strategy. Well-designed strategies play a critical role in advancing equitable mental health benefits and often serve as the foundation for equity beyond the workplace.
05
Employers should seek legal guidance if they have questions or concerns about compliance with mental health parity regulations. The DOL may demand rapid responses to its queries, so we advise employers to identify legal support before any regulatory issues may arise.
By taking these steps and periodically reviewing compliance with MHPAEA regulations, employers can comply with mental health parity regulations and ensure they are providing their employees with equitable mental health benefits. Such measures can be instrumental in supporting the psychological wellbeing of employees and illustrate a commitment to employee resilience that helps organizations build their employer brand, which can improve employee retention as well as attraction.
