Health Reform WK-EDGE EBSA updates MHPAEA self-compliance tool
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Tuesday, November 10, 2020

EBSA updates MHPAEA self-compliance tool

By Lauren Bikoff, MLS

Tool will help plan organizers in complying with mental health and substance-use disorder benefits.

The Employee Benefits Security Administration (EBSA) has released an updated tool to help employers comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) and related requirements under ERISA. According to the EBSA, the improved tool will help group health plans, plan sponsors, plan administrators, health insurance issuers, and other parties determine if a group health plan or a health insurance issuer complies with provisions of both laws relating to mental health and substance-use disorder benefits.

In general, under the MHPAEA, a group health plan or health insurance issuer that imposes financial requirements and treatment limitations on mental health and substance use disorder benefits must ensure those limitations are comparable to and applied no more stringently than those that apply to medical and surgical benefits. Financial requirements include cost-sharing requirements such as copayments, and treatment limitations include quantitative and non-quantitative limits on the scope or duration of treatment, such as visit limits or prior authorization.

"The MHPAEA ensures parity in benefits for the millions of Americans facing mental health challenges and substance use disorders," said U.S. Secretary of Labor Eugene Scalia. "The self-compliance tool we’ve updated will help these Americans obtain the treatment they need, by assisting plans and issuers in complying with the law."

The self-compliance tool was last updated in 2018. In June 2020, the EBSA proposed an updated 2020 MHPAEA self-compliance tool along with a request for comments. The agency is required under the 21st Century Cures Act to issue a compliance program guidance document to improve compliance with the MHPAEA and to update this guidance document every two years.

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