Telemedicine services are on the rise, and these services are expanding from the typical medical doctor encounters to include mental health services as well. If you are considering a telemedicine program that includes mental health services for your health and welfare plan, keep in mind that the Mental Health Parity and Addiction Equity Act (MHPAEA) applies.
While the mental health parity rules do not require a health plan to cover treatment for mental health or substance use disorder, to the extent that such treatments are covered, the rules require parity between medical/surgical benefits and mental health/substance use disorder benefits. Generally, this means parity with respect to financial requirements (such as deductibles, copays and coinsurance amounts), quantitative treatment limitations (such as number of treatments, visits or days of coverage) and nonquantitative treatment limitations (such as medical management standards and criteria for admitting physicians to a network).
Moreover, an employer cannot avoid the mental health parity requirements by carving out all mental health benefits into a separate program, or having the telemedicine program administered separately from the medical plan. Mental health parity rules will treat the medical plan and the carved out benefits as a single plan when determining whether the arrangement satisfies mental health parity requirements. If the Department of Labor finds a violation of mental health parity rules, it will require mental health claims to be reprocessed in compliance with the MHPAEA. Individuals may also sue under ERISA to enforce mental health parity requirements.
We’ve seen proposed telemedicine arrangements that have participants always paying the full cost of treatment for telemedicine services without regard to the medical plan’s cost-sharing structure. We’ve also seen proposed telemedicine arrangements with a copay structure that charges more for mental health services than for medical services. These kinds of arrangements likely violate mental health parity rules.
Some differences between the telemedicine program and the medical plan may be permitted. The mental health parity rules allow for differences in benefits between different tiers of network providers. Thus, it may be reasonable to treat the medical plan’s network as one tier of provider and the telemedicine network as a separate tier with a different copay structure. But even then, the copay amounts within the telemedicine program for medical services and for mental health services will likely have to be the same. Any differences between medical benefits and mental health benefits will need careful evaluation to ensure compliance.
We can help! If you have questions about mental health parity requirements or telemedicine programs for your group health plan, please contact your Warner attorney or Norbert Kugele or Stephanie Grant.