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Agencies Indicate Focus on MHPAEA Enforcement

The Employee Benefits Security Administration (EBSA) released a fact sheet on 2021 enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA), which summarizes closed investigations of MHPAEA violations in 2021. Federal agencies also issued a 2022 Report to Congress on the MHPAEA highlighting their recent emphasis on MHPAEA enforcement.

The MHPAEA prevents group health plans and health insurance issuers that provide mental health and substance use disorder (MH/SUD) benefits from imposing less favorable limits on those benefits than on medical and surgical coverage. According to the 2022 Report to Congress, health plans and health insurance issuers are failing to deliver parity for MH/SUD benefits.

Federal agencies indicated that they have significantly increased MHPAEA enforcement activities. In 2021, EBSA investigated MHPAEA violations in the following categories:

  • Annual dollar limits and aggregate lifetime dollar limits;

  • Benefits in all classifications (MH/SUD benefits generally must be provided in every classification in which medical/surgical benefits are provided);

  • Financial requirements;

  • Treatment limitations; and

  • Cumulative financial requirements and quantitative treatment limits.

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