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5 new parity traps that could ruin your benefits clients

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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.

See also: Tri-agency advice: What a mental health counselor should ask a plan

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.

See also: Feds: ERISA plans must share their decision support tools


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.

See also: Alkermes rises on U.S. approval of schizophrenia drug

Pass or fail

3. Progress requirements

Requiring a patient to try a relatively low-cost outpatient care option before the patient can try a more expensive outpatient treatment option is a red flag.

See also: Mental parity enforcement fight looms

Kicking a wall

4. Treatment attempt requirements

Requiring a substance use disorder patient to try, and fail, at two forms of outpatient treatment before the patient can try inpatient rehabilitation treatment is a red flag.

See also: How psychiatrists are failing the patients who need them most


5. Written treatment plan deadlines

Requiring a mental health or substance abuse disorder services provider to supply a written, individualized treatment plan within seven days is a red flag.

EBSA officials describe what appears to be a real plan provision requiring a patient’s behavioral health treatment plan to address a patient’s “nutritional, social, medical and substance abuse needs,” based on a “complex bio-psychosocial evaluation.”

The plan or issuer that created the written treatment plan requirement in the example wants the plan to be reviewed at least once a week, according to EBSA.

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