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Eating Disorders are Mental Health Conditions Subject to Parity Law

The Departments of Labor, Treasury and Health and Human Services (Departments) continue to issue FAQs addressing the implementation of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as amended by the Affordable Care Act and the 21st Century Cures Act (Cures Act). The MHPAEA prohibits group health plans from imposing financial requirements and treatment limitations on mental health and substance use disorder benefits that are more restrictive than the requirements imposed on medical and surgical benefits. The Cures Act requires the Departments to solicit public feedback regarding how to improve required disclosures under the MHPAEA. The FAQs in Part 38 contain the same request for public comment that was in Implementation Part 34, and provide a draft model form that can be used by participants to request information from a health plan regarding nonquantitative treatment limitations (NQTL) that may affect their mental health and substance use disorder benefits, or to obtain documentation after an adverse benefit determination involving these benefits.

In addition, the FAQs provide guidance regarding eating disorder coverage. If a plan provides these benefits, FAQ-1 in Part 38 confirms that the coverage must comply with the MHPAEA. The guidance indicates that “eating disorders are mental health conditions and therefore treatment of an eating disorder is a ‘mental health benefit’ within the meaning of that term as defined by MHPAEA.”  Plans should be reviewed to determine whether financial requirements and treatment limitations placed on eating disorder treatment comply with the parity requirements under the MHPAEA.

This post was written by Sarah Roe Sise of Armstrong Teasdale LLP.

For more legal analysis check out the National Law Review.

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