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California Expands Mental Health Parity Requirements

California recently enacted Senate Bill 855 (?Ç£SB 855?Ç¥), which expands certain requirements related to mental health and substance use disorders. SB 855 applies to any California ?Ç£health care service plan contract?Ç¥ or disability insurance policy issued, amended, or renewed on or after January 1, 2021. Significantly, SB 855 renders ?Ç£void and unenforceable?Ç¥ any provision in a health care service plan contract that reserves discretionary authority to the plan to determine eligibility for benefits or coverage, interpret the terms of the contract, or provide for standards of interpretation or review that are inconsistent with California law. If this provision is not preempted by ERISA as applied to an employer-sponsored group health plan, such mandate could eliminate the deferential standard of review that would otherwise be available under ERISA to the plan administrator. SB 855 is available here.

Court Finds Plausible Claim for Violation of Mental Health Parity and Addiction Equity Act

In Peter E. and Eric E. v. United Healthcare Services, Inc., the plaintiffs, a father and son, brought a claim against the defendants for violation of the federal Mental Health Parity and Addiction Equity Act (the ?Ç£MHPAEA?Ç¥), alleging that the group health plan?ÇÖs denial of continued coverage for the dependent son?ÇÖs mental health and substance abuse treatment violated the MHPAEA. This alleged violation, the plaintiffs argued, resulted in an impermissible disparity under the MHPAEA because equivalent mental health/substance abuse benefits were denied, but analogous levels of medical/surgical benefits would have been covered under the plan. Holding that the plaintiffs had alleged sufficient facts to show they had a plausible claim for a violation of the MHPAEA, the court denied the defendants?ÇÖ motion to dismiss and allowed the case to proceed to trial. Although this court?ÇÖs opinion is controlling only in the jurisdiction in which it was issued (Utah), the case… Continue Reading

Reminder to Evaluate Health Plan Restrictions on Mental Health Benefits

Many employers that sponsor group health plans for their employees are starting now to consider plan design changes for 2018. As part of this process, it is advisable to evaluate the non-quantitative limitations and restrictions on mental health and substance use disorder benefits in their health plans. Under federal mental health parity rules, the processes and factors used to apply these restrictions and limitations to mental health benefits must be comparable to, and applied no more stringently than, the processes and factors used for the plan’s restrictions on medical and surgical benefits. Considering the rare bipartisan support in Washington, D.C. for enforcement of these rules, as well as recently issued guidance on the documentation plans must be able to produce regarding such restrictions (see our prior blog post on that guidance), ensuring compliance with these rules is critical to avoid penalties and litigation. The DOL has issued a document listing… Continue Reading

Final Regulations Issued under the Mental Health Parity and Addiction Equity Act

The Departments of Labor, Health and Human Services, and the Treasury jointly issued final regulations (?Ç£Final Regulations?Ç¥) implementing the Mental Health Parity and Addiction Equity Act (the ?Ç£Act?Ç¥). ?áIn general, the Final Regulations ensure that health plan features, such as copays, deductibles, and visit-limits, are not more restrictive for mental health/substance abuse disorder benefits than they are for medical/surgical benefits. In connection with the Final Regulations, the Centers for Medicare and Medicaid Services issued a set of FAQs addressing implementation of the Act, as amended by the Affordable Care Act.?á The Final Regulations generally apply to group health plans and health insurance issuers offering group health insurance coverage for plan years beginning on or after July 1, 2014.?á Until the Final Regulations become effective, health plans and issuers subject to the Act must continue to comply with the Interim Final Regulations issued under the Act. A copy of the Final… Continue Reading

November 2021