By: Kevin Brady, Esq. On September 5, 2019, the Department of Labor (DOL) issued FAQs in an effort to promote compliance and clarify confusion surrounding the final mental health parity regulations. Generally, the Mental Health Parity and Addiction Equality Act (MHPAEA) requires that any quantitative (ex. visit limits and out of pocket amounts) and non-quantitative (ex. medical management, step therapy and pre-authorization requirements) treatment limitations on mental health conditions or substance use disorder (MH/SUD) benefits are offered in parity with medical and surgical benefits. Essentially, mental health parity laws ensure that group health plans, who choose to offer MH/SUD benefits (self-funded plans are not required to do so), cannot discourage their plan participants from taking advantage of them. As one of the more nuanced and complicated issues in our industry, compliance with the MHPAEA is always a frequent topic with our clients. While providing overall clarity to the final regulations, the FAQs also provide several examples that illustrate what compliance with the MHPAEA may actually look like in practice. Here are some of the things that stuck out: NQTLs – Group health plans cannot impose a non-quantitative treatment limitations (NQTL) on MH/SUD benefits unless the plan applies the same or similar processes, strategies, evidentiary standards, or other factors when applying the limitation to medical/surgical benefits. The FAQs further clarify that compliance should be evaluated based on both the plan language itself and the application of that language. Groups cannot apply NQTLs to MH/SUD benefits more stringently than they would medical/surgical benefits. Condition Specific Exclusions - The DOL also clarified that a group health plan may exclude all benefits for a particular MH/SUD without giving rise to parity concerns. Up until the final FAQs, many believed that an exclusion for all benefits for a particular condition would constitute a treatment limitation and therefore non-compliance. The DOL rationalized that an exclusion for all benefits related to a specific condition cannot be considered a treatment limitation on a benefit, because the benefit is not being offered in the first place. Disclosure requirements - Groups must disclose the criteria relied upon for medical necessity determinations to both plan participants and their healthcare providers. The DOL also clarified that groups should include information regarding mental health and substance use disorder benefits in their SPDs and SBCs. All in all, the FAQs provide much needed guidance on a number of issues that face group health plans. As we approach renewal season, groups are encouraged to review their plan language for potential mental health parity concerns. Groups should also review the underlying processes and strategies involved in the application of that language to ensure that the plan is in “operational compliance” as well.