Mental Health Parity Rules and Requirements for Plan Sponsors and Administrators

The requirements of the MHPAEA and DOL enforcement actions provide significant challenges for plan sponsors in ensuring that their health plans remain compliant. In addition to the strict requirements under the MHPAEA, health plans providing mental health and substance use disorder (MH/SUD) benefits must ensure compliance with CAA requirements and IRS and DOL regulations.

In recent years, the DOL announced millions in settlements related to violations of the MHPAEA and its intent to make health plan compliance a priority in enforcement actions and audits. In addition, the Employee Benefits Security Administration commenced an audit program for compliance with MHPAEA, including making requests for the "comparative analysis" required by the CAA.

All group health plans that provide MH/SUD benefits must comply with parity rules, with limited exceptions. Benefits counsel and advisers must address the risks to plan sponsors and insurers by reassessing current health plans, adhering to the MHPAEA rules and disclosure obligations under ERISA, and other issues that result in DOL audits or class action lawsuits. Under the CAA, plan sponsors must perform and document comparative analysis of the design and application of nonquantitative treatment limits (NQTLs) and the duty to disclose this analysis and related information to the DOL on request.

Listen as our panel discusses the legal requirements of the parity rules, CAA requirements, ERISA disclosure requirements, DOL enforcement of parity violations, and techniques for handling DOL health plan audits and plaintiff lawsuits.