<nobr>Jul 2, 2010</nobr>

DOL Posts New FAQ Addressing Mental Health Parity Rules

The Department of Labor's Employee Benefits Security Administration on June 30 issued on its website a Frequently Asked Question that responds to a key concern of ERIC members with respect to complying with the mental health parity interim final regulations.

Several ERIC members have indicated that they are experiencing a severe problem in complying with the mental health parity interim final regulation published on February 2, 2010, and effective for plan years beginning on or after July 1, 2010.

The general parity requirement of this regulation prohibits a plan from applying any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation applied to substantially all medical/surgical benefits in the same classification.

DOL notes in the FAQ that, since the interim final regulations were issued, some plans and issuers have stated that it is common with respect to outpatient benefits for plans and issuers to require a copayment for office visits (e.g., physician or psychologist visits) but coinsurance for other outpatient services (e.g., outpatient surgery, facility charges for day treatment centers, laboratory charges, or other medical items).

In short, until publication of the final regulation, plans essentially will be granted a non-enforcement safe harbor that allows them to divide benefits furnished on an outpatient basis into two sub-classifications for purposes of applying the law's financial requirement and treatment limitation rules: (1) office visits, and (2) all other outpatient items and services.

This presumably is intended to alleviate the problem experienced by many plans where they are unable to pass the "substantially all" test in the regulation because they apply both coinsurance and copayments to services within the established six categories heretofore permitted by the regulation.

Questions or comments on this issue should be addressed to either Gretchen Young, gyoung@eric.org or Adam Solander, asolander@eric.org.

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Websites:

DOL Frequently Asked Question

Link to Interim Final Rule

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