Recently, the DOL, HHS, and Treasury jointly issued FAQs providing guidance on a number of mental health parity and ERISA topics, including the following:
- Document disclosures. The FAQs emphasized group health plan obligations to provide copies of plan procedures, standards, and documents upon request, particularly with respect to claim denials. The DOL has issued a template that plan participants can (but are not required to) use when making document requests related to mental health and substance use disorder benefits.
- Provider directory. The FAQs also noted that a group health plan’s provider directory “must be up-to-date, accurate, and complete (using reasonable efforts).” Although “reasonable efforts” are not defined, we recommend that plan sponsors verify efforts to ensure provider directory accuracy with their third-party vendors.
- Comparable processes. A number of the FAQs focused on the requirement to apply plan rules and processes to mental health/substance use disorder treatments in the same manner that they apply to medical surgical treatments. This requirement applies to: provider reimbursement formulas, network adequacy measures, step therapy protocols, application of experimental/investigational standards to autism spectrum disorder treatment, treatment guidelines for opioid use disorder medications, and standards for covering residential treatment for eating disorders, among others.
More details are available in our most recent regulatory/compliance update webinar.
We recommend that employers:
- Review current plan documents, policies, and procedures to ensure compliance with the new guidance; and
- Work with HR, legal, and any third-party vendors to determine what disclosure, policy, or procedure changes are needed, if any.