Compliance Stuff

Employer-sponsored group health plans operate at the intersection of multiple federal regulatory frameworks — ERISA, the ACA, COBRA, HIPAA, the Mental Health Parity and Addiction Equity Act (MHPAEA), and more. Each imposes its own documentation requirements, reporting deadlines, and operational obligations. The challenge for most employers is not a lack of intent to comply, but the sheer complexity of keeping pace with layered and frequently updated rules. A proactive, systematic compliance review conducted with legal guidance is one of the most effective tools employers have to reduce legal exposure, strengthen plan governance, and prepare for regulatory inquiries . The following overview identifies the key compliance areas that such a review should cover. Plan Governance and ERISA Documentation ERISA requires every welfare benefit plan to be maintained pursuant to a written plan document that satisfies specific requirements. Compliance reviews routinely reveal documentation gaps that...

At a Glance DOL/HHS/Treasury have announced an enforcement pause of the MHPAEA 2024 Final Rule. Certain pre-2024 requirements still apply. The U.S. Departments of Labor, Health and Human Services, and Treasury have announced that they will pause enforcement of the 2024 Mental Health Parity and Addiction Equity Act (MHPAEA) Final Rule (the “2024 Final Rule”) for 18 months. 1   This action, prompted by litigation brought by the ERISA Industry Committee (“ERIC”), complicates compliance obligations of plan sponsors (employers) and health insurers, who must now contend with both the paused Final Rule and continuing MHPAEA obligations. The MHPAEA Framework: Understanding the Layers MHPAEA, enacted in 2008, requires certain group health plans and health insurers offering mental health/substance use disorder (MH/SUD) benefits to ensure parity with medical/surgical (M/S) benefits across six benefit classifications. The statute addresses financial elements (copays, deductibles, coinsurance,...

  Last week, the Departments of Labor, Treasury, and Health and Human Services finalized   regulations   implementing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).  Although the final regulations step back from certain burdensome aspects of the proposed rules (which we blogged about   here ), compliance with the final rules w ill require action from virtually all group health plans that cover mental health and substance use disorder (MH/SUD ) benefits before the end of the year. How did we get here? MHPAEA requires that group health plans that provide MH/SUD benefits cover them in parity with medical and surgical benefits .  Evaluation of whether benefits are in parity is performed for each classification of benefits under the plan, and this analysis requires evaluating: (1) financial and other quantitative treatment limitations, and (2) non-quantitative treatment limitations (NQTLs).   At the end of 2020, Congress added a require...

  On September 9, the US Departments of Labor, Treasury, and Health and Human Services (the Departments) jointly r eleased a final rule to ensure that group health plans comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) . The final rule, which spans over 530 pages, limits the ability of group health plans to restrict coverage for mental health and substance use disorders compared to medical and surgical care. The final rule largely tracks the Departments’ July 2023 joint proposed rule but includes some changes. A link to the final rule is  here .   As detailed in a prior  alert  addressing the proposed rule, the final rule outlines the requirements for group health plans to collect and analyze data related to nonquantitative treatment limitations (NQTLs). NQTLs refer to the nonnumerical tools that plans may use to limit access to care and benefits for mental health and substance use disorders. Examples of NQTLs include prior authorization ...