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DOL releases final 2020 MHPAEA self-compliance tool

Benefits Administration and Outsourcing|Health and Benefits|Total Rewards|Integrated Wellbeing
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By Maureen Gammon and Kathleen Rosenow | November 17, 2020

The final version includes best practices for internal compliance strategies and warning signs that action might be needed to ensure MHPAEA compliance.

The Department of Labor (DOL) has released the final 2020 MHPAEA Self-Compliance Tool, incorporating the changes it proposed in June1 with some minor modifications and clarifications. The tool is intended to help group health plans evaluate compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA).

While no compliance obligations have been added since the tool was last updated in 2018, the final 2020 version integrates recent DOL guidance, adds compliance examples, provides best practices for internal compliance strategies for group health plans, provides more “warning signs” that may require additional review to ensure MHPAEA compliance and provides a tool for comparing group health plan reimbursement rates to Medicare reimbursement rates.

Specifically, the 2020 Self-Compliance Tool makes the following changes in response to comments received:

  • Integration of recent guidance: The final tool clarifies how methods for establishing provider reimbursement rates must comply with MHPAEA’s requirements for nonquantitative treatment limitations (NQTLs). For example, the tool clarifies that requirements for NQTLs apply to methods for establishing both in-network and out-of-network provider reimbursement rates. The DOL has also added an introduction to the tool for comparing provider reimbursement rates to Medicare rates that explains the tool’s purpose and how it might be used.
  • Best practices for establishing an internal compliance plan: Although an internal compliance plan is not required under the MHPAEA, the 2020 tool includes the following language recommending clear protocols and documentation of internal monitoring and compliance reviews that are delegated to other entities:
  • Addition of warning signs: The DOL added and omitted specific warning signs and clarified others that were included in the proposed update. Specifically, a warning sign for potential noncompliance regarding establishment of provider reimbursement rates has been added. The proposed tool listed “Inequitable reimbursement rates established via a comparison to Medicare” and “Lesser reimbursement for MH/SUD physicians for the same evaluation and management (E&M) codes” as provider reimbursement warning signs. The final tool also lists “Consideration of different sets of factors to establish reimbursement rates” (meaning a plan generally considers market dynamics, supply and demand, and geographic location to set reimbursement rates for medical/surgical benefits, but considers only quality measures and treatment outcomes in setting reimbursement rates for MH/SUD benefits). The DOL also removed the warning sign related to drug screenings.

Going forward

The DOL is required to update the tool in 2022 but will likely issue other MHPAEA guidance before then.

Plan sponsors should review the Self-Compliance Tool to better understand the MHPAEA compliance requirements. Full MHPAEA compliance testing should be considered if a plan sponsor has not tested in the past or has changed its plan design since last testing.

Footnote

1 See “DOL proposes update to MHPAEA self-compliance tool,” Insider, July 2020

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Senior Regulatory Advisor, Health and Benefits

Senior Regulatory Advisor, Health and Benefits

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