Under the requirements of the Mental Health Parity and Addiction Equity Act of 2008, the Employee Benefits Security Administration starting this year must present a biannual report to Congress outlining the agency’s progress in implementing and enforcing — along with HHS and the IRS — the law. In January, EBSA submitted the first of such reports.
I admit I didn’t read the entire report, and doubt that I will. However, I did pick up on a few resounding themes:
1. MHPAEA’s enforcement hierarchy is pretty convoluted.
“DOL and the IRS generally have enforcement authority over private sector employment-based plans that are subject to ERISA,” the report reads. Ah, if only it were that simple. The report continues, “HHS has direct enforcement authority with respect to self-funded non-Federal governmental plans. While State insurance commissioners have primary authority over issuers in the large group market, HHS has secondary enforcement authority. Therefore, if there is a complaint regarding MHPAEA, the departments generally collaborate with one another, as appropriate, on any investigations and broad-based compliance assistance efforts.”
When was the last time you heard about multiple federal agencies collaborating — effectively, mind you — on anything? Don’t worry; I’ll wait.
2. Apparently, EBSA thinks your benefits broker/adviser is your employees’ main MHPAEA contact.
“Benefits advisers are often the first point of contact for participants, beneficiaries, group health plans and issuers,” the report states, noting that advisers are “fielding inquiries related to individuals' mental health parity-related rights and benefits and plan compliance with the requirements of rules.” The report goes on to advocate for “proper benefits adviser training” toward implementing MHPAEA effectively.
Perhaps EBSA has a different working definition of “adviser” than I do, but I don’t really come across employees who know their company’s broker/adviser’s name or phone number. And if they do, they certainly aren’t calling them up if they have a question on mental health parity. So long as in-house HR/benefits staff get those calls, that’s where the training dollars should be headed, IMHO. Might be time to start a letter-writing campaign on that one.
3. There still is a long, long way to go toward achieving true parity for mental health benefits.
The agency itself admits in the report that there have been “challenges” in implementing and enforcing MHPAEA, especially in recent years, as health care reform has been added to the mix. To help smooth the rough spots, EBSA has created a four-pronged infrastructure strategy: Issuing interpretive guidance, conducting external outreach and compliance assistance activities, providing participant assistance and enforcing the law and regulations.
That sounds reasonable and well-meaning, yet EBN has heard a much different account from the boots on the ground. Click to read EBN’s two-part series on the challenges of implementing MHPAEA (Part 1; Part 2).
Then, as always, share your thoughts in the comments about how your company has fared in overseeing the law.
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