What must plans do under MHPAEA regarding disclosure requirements?

Under the Mental Health Parity and Addiction Equity Act (MHPAEA), plans are required to adhere to specific disclosure requirements that ensure transparency and accountability with respect to mental health and substance use disorder benefits. One of the critical aspects of these requirements is that plans must provide criteria used to determine medical necessity for mental health and substance use disorder services. This includes making available the reasons for any denials of claims related to these services. By doing so, the MHPAEA aims to facilitate a clearer understanding for individuals regarding the decision-making process of their health plans, ensuring that they are informed about why certain services may not be covered or deemed medically necessary. This contributes to fair treatment and helps beneficiaries navigate their health benefits more effectively.

The focus on medical necessity criteria and the rationale for denials is integral in promoting transparency, empowering consumers, and supporting equity in mental health and substance use disorder treatment compared to medical and surgical benefits.