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Model form helps employees request information about mental health benefit limits
Employers can expect some challenging information requests about the mental health and substance abuse benefits they offer to employees and their dependents, if a draft form released by federal regulators is any indication.
The form—which was included as part of
an FAQ issued on June 16 by the U.S. Department of Labor (DOL), U.S. Department of Health and Human Services (HHS), and U.S. Department of the Treasury—is designed to help plan participants, health care providers and others exercise their rights related to mental health and substance use disorder benefits under the federal Mental Health Parity and Addiction Equity Act (MHPAEA).
Employers could receive these information requests directly, though they would likely be routed to third-party administrators or insurers in most cases. The federal agencies are accepting comments from employers and others on the model form until Sept. 13, 2017.
Only three pages long,
the model form focuses on one of the more complicated aspects of the MHPAEA: its rule against applying nonquantitative treatment limitations (NQTLs), such as process or evidentiary standards, more stringently to mental health and substance use disorder benefits than they are applied to medical or surgical benefits. (The form does not cover quantitative limits such as caps on office visits or counseling sessions.) Participants could use the form before receiving treatment or as part of an effort to challenge a claim denial related to those limits.
By filling out the simple form, participants would be requesting that a plan:
This is certainly more information than has typically been sought about mental health and substance use disorder benefits and may be more information than plans or third-party administrators would typically provide even in response to specific requests.
Additionally, federal regulators are seeking public comments on the following issues that were raised in an earlier FAQ:
[SHRM members-only: Managing Employee Assistance Programs]
Renewed Federal Interest
model form and
background information can be found on the
Centers for Medicare and Medicaid Services website and the
DOL's website respectively.
The draft form and related guidance is only the latest indication of renewed federal interest in mental health and substance use disorder benefits. Under
the 21st Century Cures Act, which was signed into law with bipartisan support in late 2016, employers could expect increased enforcement, along with stricter interpretations, of existing federal parity requirements. Though it did not expand the federal mental health parity rules, the 21st Century Cures Act directed the DOL, HHS, and Treasury Department to issue detailed mental parity compliance guidance in 2017.
Federal and state authorities are also to cooperate more closely in enforcing the parity rules under the 21st Century Cures Act. In addition, when a group health plan or insurer is found to have violated the rules five times, the department secretaries are directed to audit the plan or insurer's documents the following year to "help improve compliance."
The 21st Century Cures Act also "clarified" that, under the current mental health parity standards, if coverage is offered for eating disorder treatment, then treatment (including residential treatment) must be provided consistent with the mental health parity rules. The new FAQ also requests comments on the application of the mental health parity rules to benefits for eating disorders.
Timothy J. Stanton is an attorney in the Chicago office of Ogeltree Deakins, providing counsel to benefits and HR executives. Richard C. Libert is an attorney in the firm's Indianapolis office, and has practiced in the ERISA/employee benefits field for over 14 years. © Ogletree Deakins. All rights reserved. Reposted with permission.
Related SHRM Articles:
Mental Health Support Begins by Recognizing the Need,
SHRM Online Benefits, December 2016
DOL Ramps Up Mental Health Parity Investigations,
SHRM Online Employment Law, December 2016
Mental Health Parity Update: Proposed Disclosure Forms, Status of Eating Disorder Treatments, Conduent, July 2017
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