The Mental Health Parity and Addiction Equity Act (MHPAEA) became law in 2008 but wasn't "given teeth" until Congress passed the Consolidated Appropriations Act, 2021 (CAA, 2021), which requires employers to evaluate their compliance with the MHPAEA and ensure they provide equal coverage limits for mental health/substance use disorder benefits and medical/surgical benefits. Last April, the Department of Labor (DOL) issued guidance to help plan sponsors and administrators comply with the stepped-up compliance requirements.

Employers that sponsor physical health and mental health coverage are on notice that they can face DOL enforcement actions and be sued by employees if they fail to provide equal coverage for mental health issues, said Jay Kirschbaum, benefits compliance director and senior vice president at World Insurance Associates, based in Washington, D.C.

Parity in coverage has posed a problem for insurance carriers, Kirschbaum said March 29 at the Society for Human Resource Management's Employment Law & Compliance Conference in Washington, D.C. "There's no X-ray to show if you have ADHD [attention-deficit/hyperactivity disorder]," he noted. "You can't diagnose people in half an hour," which is how long many telehealth providers allow to evaluate and prescribe medication for a physical ailment, for example.

Coverage Parity

Mental health parity rules are directed at both insurance carriers and employer-sponsored group health plans. Fully insured...

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