U.S. Department of Labor Updates Tool to Determine If Health Plans or Insurers Comply with Mental Health Parity and Addiction Equity Act

WASHINGTON, DC – The U.S. Department of Labor’s 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 the Employee Retirement Income Security Act of 1974 (ERISA).

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.

“The Mental Health Parity and Addiction Equity Act 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’re updating today will help these Americans obtain the treatment they need, by assisting plans and issuers in complying with the law.”

“We improved our self-compliance tool based on valuable feedback received in the public comment process. The tool promotes understanding and compliance with the Mental Health Parity and Addiction Equity Act,” said Acting Assistant Secretary for the Employee Benefits Security Administration Jeanne Klinefelter Wilson. “The Employee Benefits Security Administration is committed to providing compliance assistance to group health plans, plan sponsors, plan administrators and health insurance issuers to help them meet their responsibilities under the law.”

The Department last updated the MHPAEA Self-Compliance Tool in 2018. On June 19, 2020, in coordination with the Departments of Health and Human Services and the Treasury, EBSA proposed an updated 2020 MHPAEA Self-Compliance Tool along with a request for comments from stakeholders, and EBSA is now issuing the final 2020 MHPAEA Self-Compliance Tool with modifications in response to these comments. 

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 copays, and treatment limitations include quantitative and non-quantitative limits on the scope or duration of treatment, such as visit limits or prior authorization.

Under the 21st Century Cures Act, Congress directed the U.S. Departments of Labor, Health and Human Services, and the Treasury to issue a compliance program guidance document to improve compliance with the MHPAEA, and to update this guidance document every two years.

EBSA’s mission is to assure the security of the retirement, health, and other workplace-related benefits of America’s workers and their families. EBSA accomplishes this by developing effective regulations; assisting and educating workers, plan sponsors, fiduciaries, and service providers; and vigorously enforcing the law.

The mission of the Department of Labor is to foster, promote and develop the welfare of the wage earners, job seekers and retirees of the United States; improve working conditions; advance opportunities for profitable employment; and assure work-related benefits and rights.