COTF: Mental Health Parity Update

Is your health plan ready for a closer look at mental health benefits? The Department of Labor has shared where it plans to focus its mental health parity enforcement, and plan sponsors will want to know what made the list. In this episode of Comply on the Fly, Karen breaks down the DOL’s latest guidance in plain terms, including what is still required and which plan sponsors should pay the closest attention.

Three mental health parity enforcement priorities

• Separate treatment limitations, including exclusions. The DOL will focus on blanket exclusions that apply only to mental health or substance use disorder benefits. Narrower exclusions may be reviewed too.
• Medical necessity standards and review processes. Expect a look at prior authorizations, concurrent reviews, and retrospective reviews. Plans need to show that the guidelines for mental health and substance use disorder benefits are comparable to, and not applied more stringently than, those for medical-surgical benefits.
• Network adequacy. The focus is on network admission standards and provider reimbursement. Where parity issues exist, plans should consider all options and help participants find treatment without out-of-network costs caused by a lack of in-network providers.

Press play for a clear, plain-language look at what the DOL is prioritizing and who should be paying attention. For more detail, the DOL’s enforcement guidance tool is available on the DOL website.

_{Please Note: This podcast and the contents herein do not constitute legal advice. Seek the advice of counsel for any benefit compliance related implementation guidance or strategy}.

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