Last fall, Congress ratified the Mental Health Parity and Addiction Equity Act as a permanent federal law.

Here’s what your company must do now to ensure compliance:

1. Review plan documents

If you have 50 or more employees, your first step is to review the wording of your mental health plan documents.

Under the terms of the law, your organization must give employees and dependents the same access to therapy and related mental health and addiction recovery treatments that  it does for medical and surgical treatments for physical conditions.

From a legal standpoint, the plan documents for mental health benefits must have the same wording as your medical plan. Specifically:

• If your mental health benefits are carved out from the rest of your medical benefits – e.g., through an EAP provider – this may require
  you to write a new summary plan document, or
• If your mental health benefits are already integrated with your medical plan, you may need to clarify that physical and mental conditions are handled identically.

In particular, make sure there’s the same language for hospitalization benefits and covered out-patient visits.

2. Review administrative practices

From an administrative standpoint, the law requires identical treatment of employees’ shares of:

• deductibles
• copays
• out-of-pocket maximums (including medication costs), and
• monthly premiums.

In terms of plan design, your company still has discretion to not offer mental health benefits. The law also doesn’t force you to add an EAP or have mental health specialists in your PPO network.

3. Examine disability procedures

When it comes to paid disability or FMLA requests, it’s legal to require employees to prove they’ve been diagnosed with a mental health condition or they’re undergoing addiction-related treatment.

Keep in mind, however, that you’re still expected to comply with HIPAA’s privacy and non-discrimination standards.

No two ways about it: Handling mental health related disabilities and accommodations is tricky – and filled with legal pitfalls.

How far does your organization need to go to honor such requests? Start by looking at the employee’s job description.

The key issue to determine is whether he or she is able to perform essential job functions.

In most cases, your best bet is go with what the mental health provider recommends – or ask for clarification if there is no recommendation.
Qualified providers include psychiatrists, psychologists and licensed clinical social workers.

Assuming the employee’s condition is legitimate, federal law requires you to approve requests for mental health related leave or other accommodations.

But the accommodation needn’t always be permanent. Example: The problem may be controlled by change in medication.

Keep in mind: The purpose of the new law is to provide affected workers equal – not preferential – treatment.

Tags: Mental Health Parity Act