ERIC Urges Balance on Implementing Regulations under Mental Health Parity Act

The ERISA Industry Committee (ERIC) earlier today submitted comments to the Department of Labor’s Employee Benefits Security Administration in response to a “request for information” regarding the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

To help them prepare guidance, the Departments of Labor, Health and Human Services, and Treasury published in the Federal Register on April 28, 2009, the request for information on the economic and regulatory impact of the MHPAEA. Enacted in October 2008, MHPAEA requires employers that sponsor group health plans for employees and their families to ensure that there is parity between the medical and surgical benefits and the mental health or substance abuse disorder benefits provided under the plans.

ERIC makes recommendations on the terms and provisions of implementing the MHPAEA, disclosure requirements, and the effective date and transition rules of the forthcoming regulations under the MHPAEA, including that:

  • The regulations should allow employers to apply the parity requirements separately to each benefit package under a group health plan.
  • The regulations should make clear that MHPAEA does not prohibit distinctions between different categories of treatment. For example, a plan should be permitted to apply the same coverage distinction to mental health and substance abuse disorder treatment by in-network and out-of-network providers.
  • The regulations should permit separate but equal financial terms and treatment limits for medical/surgical benefits and mental health/substance abuse benefits. Accordingly, the MHPAEA regulations should confirm that employers may apply separate deductibles, out-of-pocket maximums, annual and lifetime limits, and other cost-sharing requirements and treatment limitations separately to mental health and substance use disorder benefits, as long as these limits are not more restrictive than the corresponding limits for medical/surgical benefits.
  • The regulations should confirm that group health plans may continue to exclude specific mental health or substance abuse diagnoses and treatments from coverage.
  • The regulations should confirm that MHPAEA does not require parity in the management of benefits, in that it is not practicable to attempt to achieve parity in the management techniques that apply to medical/surgical benefits and mental health/substance use disorder benefits.
  • The Departments should not create any additional disclosure requirements under MHPAEA for ERISA-governed plans, since these requirements will add to the administrative burden and expense that employers must bear without providing meaningful additional protection to group health plan participants and beneficiaries.
  • The regulations should include generous transition provisions, and any regulation promulgated under MHPAEA should not be effective earlier than 12 months after it is published in its final form.
  • The definition of “collectively bargained plan” should be broad enough to ensure that the purpose of the delayed effective date is achieved.

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