U.S. Department of Labor
Health Benefits Advisor for Employers
Determining Compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) and Mental Health Parity Act (MHPA) Provisions in Part 7 of ERISA
Does the plan comply with the mental health parity provisions requiring the availability of plan information regarding criteria for medical necessity determinations?
The plan administrator (or the health insurance issuer) must make available the criteria for medical necessity determinations made under a group health plan with respect to mental health or substance use disorder benefits (or health insurance coverage offered in connection with the plan with respect to such benefits) to any current or potential participant, beneficiary, or contracting provider upon request. See 29 CFR 2590.712(d)(1).
