Eric Allen Kauk, Esq., LL.M., Author at Catholic Benefit Plans

Parity Rules for Annual and Lifetime Dollar Limits of MH/SUD Benefits Under the MHPAEA

If a group health plan (GHP) or an individual market health insurance issuer (IMHII) has established annual or lifetime dollar limits for what the plan would cover with respect to medical/surgical benefits, then the corresponding dollar limit categories for mental health (MH) and/or substance use disorder (SUD) benefits cannot be lower. Similarly, a GHP or […]

What Happens to Plans Or Issuers That Are Not Compliant With The MHPAEA:

Both the Center for Medicare and Medicaid (“CMS”) and Employee Benefits Security Administration (“EBSA”) have committed to making mental health and substance use disorder parity a top enforcement priority under the Biden administration. As a result, more efforts have been put into determining compliance with the Mental Health Parity and Addiction Equity Act (“MHPAEA”), and […]

Are MHPAEA Requirements Applicable to Your Company?

Employers that provide a group health plan (GHP) or group/individual health insurance coverage (G/I HIC) which provide either mental health or substance use disorder benefits in addition to medical/surgical benefits will typically be held responsible to comply with the standard MHPAEA requirements unless there is a qualifying exemption available. Potentially exempted plans include retiree-only group […]

The Mental Health Parity and Addiction Equity Act Is Protecting Eating Disorder Benefits:

The Mental Health Parity and Addiction Equity Act (“MHPAEA”) is taking action in helping people with mental health or substance use disorders (“MH/SUD”) get help. The Act makes it a requirement for health insurance plans to not place any additional limitations on people seeking treatment for MH/SUD that are not imposed on people seeking medical […]

Can a plan require an individual to complete a health risk assessment (HRA) prior to or as part of the enrollment process for the plan?

GINA prohibits a plan from collecting genetic information (including family medical history) prior to or in connection with enrollment. Thus, under GINA, plans must ensure that any HRA conducted prior to or in connection with enrollment does not collect genetic information, including family medical history. Under GINA, there is an exception for genetic information that […]

Will the Departments issue additional guidance on requirements that were added to MHPAEA by the Appropriations Act?

In light of the expeditious timeframes established under the Appropriations Act regarding comparative analyses of NQTLs, the Departments are issuing these FAQs to address several discrete issues. The Departments will engage with stakeholders to determine what additional guidance might be needed. […]

May a participant, beneficiary, or enrollee (or their authorized representative), or state regulator request an NQTL analysis?

Yes. Under the Appropriations Act, plans and issuers must make available their respective comparative analyses of NQTLs and other applicable information to the applicable State authority upon request. The term “applicable State authority” means, with respect to a health insurance issuer in a State, the State insurance commissioner or an official or officials designated by […]

What are examples of reasons why the Departments might conclude that documentation of comparative analyses of NQTLs is insufficiently specific and detailed?

As noted above, a general statement of compliance, coupled with a conclusory reference to broadly stated processes, strategies, standards, or other factors is not sufficient. Accordingly, comparative analyses that consist of conclusory or generalized statements without specific supporting evidence and detailed explanations or a mere production of a large volume of documents without a clear […]

What information must plans and issuers make available in response to the Departments’ requests for documentation of their comparative analyses?

Plans and issuers should ensure that comparative analyses are sufficiently specific, detailed, and reasoned to demonstrate whether the processes, strategies, evidentiary standards, or other factors used in developing and applying an NQTL are comparable and applied no more stringently to MH/SUD benefits than to medical/surgical benefits, as described further below. To that end, a general […]

When must plans and issuers make available their NQTL comparative analyses, as required by the Appropriations Act?

Plans and issuers that offer both medical/surgical benefits and MH/SUD benefits and impose NQTLs must make their comparative analyses of the design and application of NQTLs available to the Departments or applicable State authorities upon request, beginning 45 days after the date of enactment of the Appropriations Act. Because the Appropriations Act was enacted on […]