The U.S. Department of Labor (DOL) recently released a draft model form for plan participants to request disclosures from group health plans and insurers about restrictions on mental health coverage. The form is designed to assist plan participants requesting information under the Mental Health Parity and Addiction Equity Act (MHPAEA).

The form requests information on factors, methods, and analyses used to develop any plan limits on mental health and substance use disorder benefits. It also asks for the "evidence" used to determine that those factors are applied no more stringently than limits on comparable medical and surgical benefits—as required by the MHPAEA. The DOL is seeking public comments prior to finalizing the draft model form. Instructions for commenting are included in the draft model form.

Use of the form is optional when a claim was or may be denied or restricted. The form may be submitted by the participant or an authorized representative. The plan is expected to provide the information within 30 days of receipt of the request. Employer group health plan compliance programs should assure that the plan is prepared to respond to any request. Failure to comply with information request requirements of the MHPAEA may result in assessment of penalties or investigation by the DOL.

The Departments of Labor, Health and Human Services, and Treasury released FAQs consistent with the 21st Century Cures Act, enacted in December 2016. The guidance confirms that eating disorders are a mental health condition for MHPAEA purposes and that treatment benefits are subject to MHPAEA rules on benefit restrictions.

Under the new administration, changes are imminent for the Affordable Care Act and a range of other laws and regulations affecting health care and health benefits. Ballard Spahr attorneys established the Health Care Reform Initiative to monitor and analyze legislative and regulatory developments. We will continue to follow developments in this area as they emerge. Changes may come to the Health Care Reform Dashboard, but it will continue to serve as an online resource center for news and analysis on developments regarding the Affordable Care Act and health care reforms that follow.

Attorneys in Ballard Spahr's Health Care and Employee Benefits and Executive Compensation Groups represent clients across the health care industry and counsel clients on health care, benefits and tax regulatory and compliance issues, as well as privacy and data security, transactional, financing, benefits and compensation, and labor and employment matters.


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