Mental Health Parity Rules Include Eating Disorders as Mental Health Conditions

On June 16, 2017, the Department of Labor (DOL) issued FAQ 38 implementing the Affordable Care Act (ACA) as it relates to the Mental Health Parity Act and Addiction Equity Act (MHPAEA) and the 21st Century Cures Act (Cures Act). The DOL is requesting comments on a draft model form for participants to use when requesting information about nonquantitative treatment limitations as well as confirming that benefits for eating disorders must comply with the MHPAEA.

The MHPAEA requires that financial requirements such as coinsurance and copayments and treatment limitations such as visit or day limits for mental health and substance use disorder benefits are no more restrictive than those placed on medical and surgical benefits. The regulations also state that a non-quantitative treatment limitation must be comparable.

The Cures Act requires that benefits for eating disorders are consistent with the requirements of MHPAEA. The DOL in this FAQ clarifies that the MHPAEA applies to any benefits a plan may offer for treatment of an eating disorder. Plans should review their plan information to ensure compliance with these regulations and guidance.

All comments regarding disclosures and eating disorders must be submitted by September 13, 2017.

ACA FAQ Part XXV Addresses Wellness Programs

The Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury released FAQ XXV addressing the compliance of wellness programs with the Affordable Care Act.

Highlights of FAQ XXV:

  • Compliance with the wellness program regulations under ACA does not determine compliance with other laws nor does it determine the tax treatment of rewards provided by the wellness program.
  • A wellness program will comply with the requirement to be “reasonably designed” if it:
    has a reasonable chance of improving the health of, or preventing disease in, participating individuals;

    • is not overly burdensome;
    • is not a subterfuge for discrimination based on a health factor;
    • is not highly suspect in the method chosen to promote health or prevent disease; and
    • provides a reasonable alternative standard to qualify for the reward for anyone who does not meet the initial standard that is related to a health factor.

ACA FAQ Part XXII Addresses Premium Reimbursement Arrangements

The Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury released FAQ Part XXII addressing the compliance of premium reimbursement arrangements with the Affordable Care Act. Sponsors of health reimbursement arrangements (HRAs), health flexible spending arrangements (health FSAs) or other arrangements that reimburse health premiums should confirm that reimbursements are not being made for individual coverage premiums.

Specifically, the guidance provided in this set of three questions states that:

  • Employers cannot offer employees cash to reimburse the purchase of an individual policy.
  • Employers cannot offer employees at risk of high claims a choice between the group health plan or cash to obtain individual insurance.
  • Employers cannot cancel group policies, setup a Code section 105 reimbursement plan using brokers to help employees select individual policies and allow employees to access premium tax credits.