The Association’s American Health Policy Institute hosted a conversation with Department of Labor officials on mental health parity compliance and actions employers should take to avoid reputational damage by being named in DOL’s next report to Congress for failure to comply. Recommendations included reviewing summary plan documents and modifying third-party administrator contracts.
DOL planning to increase enforcement efforts on employer plans: Tim Hauser, Deputy Assistant Secretary for Program Operations, Employee Benefits Security Administration (EBSA) and Amber Rivers, Director, Office of Health Plan Standards and Compliance Assistance, EBSA stressed the “enormous effort” DOL is making to enforce the Mental Health Parity and Addiction Equity Act (MHPAEA). American Health Policy Institute President and CEO Mark Wilson moderated the discussion.
Employers should carefully review their summary plan documents (SPDs) for red flags. The first DOL report to Congress found none of the selected comparative analyses employers initially submitted contained sufficient information to determine parity compliance. DOL recommended employers carefully review their SPDs for mental health and substance use disorder treatment limitations (e.g., prior authorization or credentialing requirements) that are not imposed on medical and surgical benefits.
DOL also recommended employers:
- Modify third-party administrator (TPA) contracts and have TPAs provide:
- A list of Non-Quantitative Treatment Limitations and highlight those that may be problematic;
- A comparative analysis as required by DOL;
- Comparative network adequacy data (medical vs. mental health providers);
- Comparative claims adjudication data (look for disparate outcomes);
- List of parity warranties they are prepared to offer your company.
- Review DOL’s self-compliance tool.
DOL added that employers using a third-party to conduct their parity analysis should make sure the tools are sound and perform the appropriate evaluations because statutorily, the legal obligation is on the employer plan to be in compliance. Moreover, DOL is looking to not only fix current parity issues but to retrospectively correct parity noncompliance with a look-back period of six years.
Employers remain committed to employee wellbeing: David Kasiarz, Executive Vice President, Colleague Total Rewards and Wellbeing, American Express and Stephan Dolling, Executive Director, Global Benefits, Merck & Co., highlighted the importance of employee wellbeing and employer accountability in providing parity, starting from the moment the benefit plan is designed. However, despite employer efforts, the lack of clarity from the administration on how to comply and the inconsistency of plans providing appropriate data makes it difficult for employers to meet these standards.
Complex nature of the parity analysis leaves employers with more questions: Anne Richter, North American Co-Leader, Health Management, WTW, and Nicole Bitter, WTW Director of Compliance, both advised employers to continue monitoring their TPAs/carriers for the next few years, both in benefit design and when evaluating parity.
Outlook: Expect an additional emphasis from DOL on enforcing mental health parity requirements with public disclosures of non-compliant employers and potential civil monetary penalties. DOL stated they are willing to work with employers during the development of future guidance documents and while auditing employer plans.
