If an insurance plan is found to be non-compliant with the Mental Health Parity and Addiction Equity Act (MHPAEA), there are several actions that could be required to rectify the situation. The MHPAEA is a federal law that requires health insurance plans to provide equal coverage for mental health and substance use disorder services as they do for medical and surgical services. Here are some potential actions that could be taken:
Corrective action plan: The insurance plan may be required to develop and implement a corrective action plan that outlines specific steps and timelines to bring the plan into compliance with the MHPAEA. This plan would address any deficiencies found during an investigation or audit.
Fines and penalties: The insurance plan could face financial penalties for each violation of the MHPAEA. These penalties can vary depending on the severity and number of violations.
Reimbursement or coverage adjustments: The plan may be required to reimburse affected individuals for any denied claims or services that should have been covered under the MHPAEA. Additionally, they may need to adjust their coverage to ensure future compliance.
Oversight and monitoring: The plan could be subjected to increased oversight and monitoring by regulatory bodies to ensure ongoing compliance with the MHPAEA.
Correcting discriminatory practices: If the non-compliance involves discriminatory practices against individuals seeking mental health or addiction treatment, the insurance plan may be required to take specific actions to address these disparities and ensure equal treatment.
Suspension or termination of plan: In extreme cases of repeated and willful non-compliance, the regulatory authorities may suspend or terminate the insurance plan's ability to offer coverage until they demonstrate compliance.
Public disclosure: Non-compliant insurance plans may be subject to public disclosure of their violations to increase transparency and inform consumers.
It's essential to note that the specific actions taken would depend on the severity of the non-compliance, the number of violations, and the discretion of the regulatory authorities overseeing the implementation of the MHPAEA.
If you suspect that your insurance plan is not in compliance with the MHPAEA, you should contact your state's insurance department or the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) to report the issue and seek assistance.