The U.S. Labor Department has given benefits advisors a look at the possible shape of behavioral health parity enforcement actions to come in a new list of “warning signs.”
The Employee Benefits Security Administration (EBSA), an arm of the department, put out the warning signs notice to show how it and other federal agencies will be looking for violations of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
An earlier mental health parity law required group health plans that provide both mental health and general medical benefits to make benefits levels for both types of care comparable.
The MHPAEA was supposed to expand parity protection, by requiring any non-quantitative treatment limits (NQTLs) for both types of care to be comparable.
In the past, EBSA has said that it wanted to hire more lawyers, to help it file more mental parity compliance suits.
EBSA and two other federal agencies recently gave a mental health care provider detailed advice about how to grill an insurer about benefits treatment limits.
In the new warning signs notice, EBSA describes many “red flags” that imply that a plan or coverage issuer might be imposing the kinds of NQTLs banned by the MHPAEA.
For a look at a sampling of the warning signs listed in the notice, read on.
1. Blanket preauthorization requirement
A plan can require all patients seeking non-emergency mental health or substance abuse disorder services to go through a preauthorization process, but only if it requires all patients seeking non-emergency medical and surgical benefits to go through a similar preauthorization process.
2. Prescription drug preauthorization
Requiring different kinds of preauthorization for drugs for mental health and substance abuse disorder services than for medical and surgical services is a red flag.