On September 5, 2019, the federal government issued additional guidance regarding the Mental Health Parity and Addictions Equity Act (MHPAEA). The Frequently Asked Questions (FAQs) guidance provides answers regarding the implementation of MHPAEA, the 21 Century Cures Act, and the SUPPORT for Patient and Communities Act. It also incorporates the much talked about Model Disclosure Request Form by consumer and provider advocates.
The 11 new FAQs primarily focus on non-quantitative treatment limitations (NQTL) and disclosures examples covering a number of mental health/substance use disorder insurance coverage issues including:
The Model Disclosure Request Form (starting on page 16 of the FAQ document) is designed to help insured individuals better understand how their health plan covers mental health/substance use disorder benefits in comparison to medical/surgical benefits. The Form tracks several key parity compliance activities by asking health plans to:
Recent MHPAEA guidance clarifies that health plans and other covered entities have an obligation to disclose to plan participants and ordering providers the criteria used for medical necessity determinations, reason for denials, and the reminder to include specific information regarding MHPAEA in Summary Plan Descriptions (SPD) and Summary of Benefits and Coverage (SBC).
However, the amount of disclosure regarding the details underpinning an NQTL parity analysis is still a hotly debated subject. In most cases, the insurance industry has recommended a short summary narrative, while many consumer advocates have pushed for all underlying details of any parity comparability analysis.
No matter the level of disclosure, it is becoming more apparent that failure to disclose any details related to a parity analysis upon request is now creating a greater risk management exposure for health plans and other entities, including those that are defined as a fiduciary under the Employee Retirement Income Security Act of 1974 (ERISA), including the health plan sponsor and in many cases, the third-party administrator.
CHQI recently launched the CHQI Mental Health Substance Use Disorder (MH/SUD) Parity Accreditation Program, the nation’s first accreditation standards for health insurers and health benefit administrators to assess compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA). The program includes access to ParityManager™, a comprehensive digital resource designed to help health plans and other organizations build, implement and manage an effective parity compliance program that meets the MHPAEA disclosure requirements.
To learn more about ParityManager™ or the CHQI Mental Health Substance Use Disorder (MH/SUD) Parity Accreditation Program, contact firstname.lastname@example.org or 410-756-1300.