Many employers that sponsor group health plans for their employees are starting now to consider plan design changes for 2018. As part of this process, it is advisable to evaluate the non-quantitative limitations and restrictions on mental health and substance use disorder benefits in their health plans. Under federal mental health parity rules, the processes and factors used to apply these restrictions and limitations to mental health benefits must be comparable to, and applied no more stringently than, the processes and factors used for the plan’s restrictions on medical and surgical benefits. Considering the rare bipartisan support in Washington, D.C. for enforcement of these rules, as well as recently issued guidance on the documentation plans must be able to produce regarding such restrictions (see our prior blog post on that guidance), ensuring compliance with these rules is critical to avoid penalties and litigation.
The DOL has issued a document listing types of restrictions that employers may want to consider.