By: David Ostrowsky

It was fourteen years ago this month that the Mental Health Parity and Addiction Equity Act (MHPAEA) was signed into law. The landmark piece of legislation had a profound impact on the healthcare industry, requiring group health plans and insurance companies to provide coverage for mental health/substance use disorder treatments in parity with medical services. Indeed, the act’s passage was a momentous development that helped reduce the stigma of seeking mental health treatment. But at this hour, with an untold number of Americans suffering from mental health issues, important questions need to be addressed. Is the MHPAEA fully enforceable? Is every employer and insurer across America in full compliance with the act?

Alas, there is widespread skepticism among many House lawmakers that mental health parity actually exists in practice. In fact, in a report issued to Congress last month, the U.S. Departments of Labor, Health and Human Services, and the Treasury found rampant MHPAEA violations by providers nationwide. Subsequently, such disturbing findings proved to be the driving force behind House lawmakers last month pushing forward the Mental Health Matters Act. Introduced in May by Representative Mark DeSaulnier, (D-California) and now facing an uphill battle for passage in the Senate where many Republicans fear that penalties would drive employers to drop benefits, the Mental Health Matters Act would empower the U.S. Department of Labor to bring civil action against a plan sponsor or administrator of a group health plan for imposing more stringent restrictions on mental health and substance use disorder service benefits. Ultimately, those employers and plan administrators found to be in violation of the MHPAEA could face heavy monetary penalties, potentially ones running millions of dollars that could significantly raise costs for their respective employees/plan participants. (In addition to levying stiffer penalties for MHPAEA non-compliance, the Mental Health Matters Act would provide greater funding for school-based mental health services, including those run by Head Start programs, while increasing the number of mental health professionals working in elementary and middle schools.)

As such, it would behoove plan sponsors and administrators to ensure that their respective plans are complying with the MHPAEA — a matter of paramount importance that can be handled properly with thorough NQTL (Non-Quantitative Treatment Limitations) testing, examples of which include prior authorization requirements for in-network and out-of-network inpatient services; concurrent review for in-network and out-of-network inpatient and outpatient services; standards for provider admission to participate in a network, including reimbursement rates. In sum, undergoing a comprehensive NQTL analysis—a service The Phia Group has extensive experience offering—can help a given plan ensure that it is compliant with the parity component of the MHPAEA as a means of avoiding potential penalties stemming from a beefed-up DOL audit.