The U.S. Department of Labor has a hard time enforcing some Mental Health Parity and Addiction Equity Act (MHPAEA) requirements, and it may hire experts to help it sue plans that violate the rules, officials say in a new report to Congress.
Drafters of the 2008 law wanted to improve an older law, the Mental Health Parity Act of 1996 (MHPA), by adding strict, detailed, easy-to-enforce quantitative parity requirements.
But, in the real world, some of the MHPAEA parity requirements are difficult to apply, and statutory curbs on the authority of the U.S. Department of Labor limit the kinds of enforcement actions the department can execute, according to officials at the Employee Benefits Security Administration (EBSA), the Labor Department arm that oversees benefit plans.
MHPAEA now prohibits large group health plans that cover behavioral health care from setting different nonquantitative treatment limits for behavioral care and other types of health care.
Deciding whether a plan violates the MHPAEA parity requirements for nonquantitative treatment limits is complicated, and it takes input from experts, EBSA officials say.
EBSA “has been coordinating with experts related to open health plan investigations and will continue to evaluate the staffing and expertise needed to identify and establish violations, and, if necessary, litigate instances of noncompliance,” officials say.
EBSA conducted a total of 3,118 health plan civil investigations from 2010 through 2015 and considered MHPAEA issues when conducting 1,515 of those investigations, officials say.
About 171, or 11 percent, of the MHPAEA investigations led to citations for MHPAEA violations, according to officials.
About 58 percent involved violations of the nonquantitative treatment limit requirements, and 14 percent involved violations of provisions requiring parity for deductibles, out-of-pocket spending maximums, and other cumulative benefits limits.
When reviewing plans, “EBSA focuses on plans’ and claims administrators’ actual conduct, not just the words on the formal plan instruments,” officials say.
EBSA officials noted that a provision in the Employee Retirement Income Security Act of 1974 (ERISA) prohibits the Labor secretary from bringing enforcement actions against state-licensed health insurance issuers.
In spite of that limitation, EBSA has succeeded at working with several large insurers to remove plan provisions that violate MHPAEA requirements, officials say.
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