Do we need to include COVID-19 required testing for purposes of conducting our mental health parity analysis?
Do we need to include COVID-19 required testing for purposes of conducting our mental health parity analysis?
Q: Do we need to include COVID-19 required testing for purposes of conducting our mental health parity analysis?
A: No. Q&A 16 of these June 23 FAQs states that the relevant federal government agencies will not take into account COVID-19 testing provided without cost-sharing for purposes of the relevant mental health parity analysis.
Recall that, under the mental health parity rules, plans cannot impose cost sharing requirements on mental health and substance use disorder benefits that are more restrictive than those they apply to medical surgical benefits. In determining which cost-sharing requirement applies, the mental health parity rules divide plan benefits into six different classifications based on the setting (e.g., inpatient, outpatient, emergency, and prescription drugs) and, for inpatient or outpatient benefits, whether the coverage is provided in-network or out-of-network. Plans can only apply to mental health and substance use disorder benefits the predominant cost sharing requirement that is applied to substantially all medical surgical benefits each of those six classifications. Whether a cost-sharing requirement is “predominant” or applied to “substantially all” benefits is generally based on the amount spent by the health plan. These terms are discussed more in the FAQs and other relevant guidance.
Because COVID-19 testing could cause the “predominant” cost-sharing requirement to be $0, that could substantially change the cost sharing that can be applied to mental health and substance use disorder benefits. These FAQs confirm that plans should not have to make changes to their mental health and substance use disorder cost-sharing requirements based on providing COVID-19 testing with no cost sharing.
However, these FAQs do not apply to COVID-19 treatment or other services (such as telehealth or other remote care). Therefore, to the extent a plan provides treatment or other services without cost sharing due to the pandemic, it appears the plan will need to take those into account in doing any mental health party analysis.
Responding to COVID-19 in the Workplace
We understand that there is a significant amount of information derived from a variety of sources. The HUB team has developed this comprehensive FAQ in an effort to consolidate the various questions and answers into one document.