Mental Health Parity Audit
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that requires health insurance plans that provide mental health or substance use disorder benefits to offer those benefits at parity with medical and surgical benefits. Many states have their own mental health parity laws that may impose additional requirements.
A mental health parity audit refers to a process of evaluating and ensuring compliance with mental health parity laws and regulations. The Employee Benefits Security Administration (EBSA), a division of the U.S. Department of Labor (DOL), is actively involved in enforcing compliance with MHPAEA for group health plans sponsored by private employers.
The DOL and any plan participant, dependent, or legal representative of either can request a mental health parity analysis from the employer, which gives them a limited amount of time to produce one and respond to the request. If the DOL deems your plan non-compliant, the plan must notify all individuals enrolled in the plan of this noncompliance with MHPAEA. Participants in noncompliant plans can sue the plan sponsor under ERISA for violating MHPAEA. The Departments may also share findings of noncompliance with the state where the group health plan is located.
Your Challenge
Employers are constantly challenged with retaining and recruiting talent in a competitive modern workplace. Prioritizing mental health and substance abuse benefits contributes to the overall well-being of employees, enhances workplace productivity, and helps create a supportive and inclusive work environment. Modern workplaces often experience high levels of stress and burnout. Mental health and substance abuse benefits are crucial for addressing workplace stressors and supporting employees in maintaining a healthy work-life balance.
Consolidated Appropriations Act of 2021 (CAA) amended MHPAEA by requiring group health plans that offer both M/S and MH/SUD benefits to perform and document comparative analyses of the design and application of any Quantitative Treatment Limits (QTL) or Non-Quantitative Treatment Limits (NQTL) that apply to the plan.
Our Solution
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Conduct a comprehensive plan document review.
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Recommendations to remedy plans deemed not to be compliant with MHPAEA.
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Detailed analysis of Quantitative Treatment Limits (QTL) or Non-Quantitative Treatment Limits (NQTL).
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Detailed review of all plan documentation by MHPAEA experts, including former DOL investigators.
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Customized information requests for TPAs and other providers.
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Support plans with employer-specific carve-outs.
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Store data in a HIPAA-compliant environment.
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Provide a comprehensive plan review report.
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Perform comprehensive claims analysis.
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Generate custom plan language to govern updated policies and procedures.
Why Choose Us?
Let’s face it, compliance is complex. The consequence of farming out compliance tasks to different vendors could be that you spend a lot of time managing multiple vendor relationships, providing the same information repeatedly, and not being sure if everything is being covered. Working with Amwins ensures a cost-efficient, accurate, and timely way to ensure compliance.
Key Differentiators of Our Mental Health Parity Audit:
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Free investigation/audit support for the current and following plan year in case of a DOL investigation.
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Written comparative analysis report for each plan.
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Recommendations for corrective action (if any).
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Opinion letter provided by leading MHPAEA attorneys.
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Annual updates to account for plan changes and updated agency guidance.
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Closing conference to present results and recommendations.
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