Eating disorder is mental health condition subject to parity rules, FAQ says

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) applies to benefits a plan or issuer may offer for treatment of an eating disorder, according to a frequently asked question (FAQ) that the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) have issued. The FAQ also requests comments on whether further clarification is needed on this and disclosure issues the Departments previously raised in Affordable Care Act Implementation FAQs Part 34.
Generally, MHPAEA requires that the financial requirements and treatment limitations imposed on mental health and substance use disorder (MH/SUD) benefits cannot be more restrictive than the predominant financial requirements and treatment limitations that apply to substantially all medical and surgical benefits. MHPAEA also imposes several disclosure requirements on group health plans and health insurance issuers.
The 21st Century Cures Act (Cures Act) was enacted on December 13, 2016. Among other things, the Cures Act contains provisions that are intended to improve compliance with MHPAEA by requiring the Departments to solicit feedback from the public on how to improve disclosure of the information required under MHPAEA and other laws.

Treatment of an eating disorder.

The Departments’ regulations implementing MHPAEA define “mental health benefits” as benefits with respect to items or services for mental health conditions, as defined under the terms of the plan or health insurance coverage and in accordance with applicable federal and state law, which must be defined to be consistent with generally recognized independent standards of current medical practice.
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.
Furthermore, in light of section 13007 of the Cures Act, the Departments request comments on whether any additional clarification is needed regarding how the requirements of MHPAEA apply to treatment for eating disorders. Send comments with respect to eating disorders to by September 13, 2017.

Draft model disclosure form.

In addition, the Departments are soliciting comments on a draft model form that participants, enrollees, or their authorized representatives could – but would not be required to – use to request information from their health plan or issuer regarding nonquantitative treatment limitations that may affect their MH/SUD benefits, or to obtain documentation after an adverse benefit determination involving MH/SUD benefits to support an appeal.
A copy of that draft model form, as well as instructions and deadlines for commenting on it, can be found at or
The Departments request comments on any aspect of the draft model form, including ways to reduce burden on individuals, families, health care providers, states, group health plans, health insurance issuers, and other stakeholders, as well as the use of alternate means of receiving information requests from consumers. Send comments on these disclosure issues to by September 13, 2017.

SOURCE: FAQs about Mental Health and Substance Use Disorder Parity Implementation and the 21st Century Cures Act, Part 38, June 16, 2017.
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