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pant upon request.95
Federal implementation and enforcement of the MHPAEA is handled by
three agencies—the HHS, the Department of Treasury (“DOT”), and the
Department of Labor (“DOL”).96 Together, these departments work to
promote broad-based compliance assistance efforts and investigate
MHPAEA complaints.97 The Departments receive complaints from group
health plan participants and beneficiaries, enrollees in individual market
health coverage, providers, and other stakeholders, and then work with
these individuals and the regulated community to correct violations.98
Ongoing enforcement of the MHPAEA falls to different authorities depending on the type of insurance plan at issue.99 State authorities, typically
insurance commissioners, are responsible for enforcing the parity law’s
mandate in the large group market, and overseeing individual and employer-funded plans with fewer than fifty-one insured employees.100 Federal authorities also have a role, as the DOL and the Internal Revenue Service
(“IRS”) are responsible for enforcement of the parity law over private sector employment-based plans subject to ERISA, while HHS is responsible
for self-funded non-Federal governmental plans.101 Additionally, HHS may
intervene to enforce rights in the individual or group markets if it determines a state has failed to “substantially enforce” the MHPAEA.102
In November 2013, the DOT, DOL, and HHS issued a final rule fully
implementing the MHPAEA.103 The regulation directly addressed enforcement, declaring that state insurance commissioners will be the main en-
95. SOLIS, supra note 91, at 8.
96. SOLIS, supra note 91 at 4, Enforcement, 6-7. (explaining efforts are allocated between HHS, DOT, and DOL because the MHPAEA amended ERISA, PHSA, and the IRS
code with parallel provisions. Accordingly, it is considered a “tri-agency rule,” and the Departments share enforcement efforts based on long-standing precedent.); See also Alden
Bianchi, Final Regulations Issued under the Mental Health Parity and Addiction Equity Act
of 2008, MINTZ LEVIN (Dec. 13, 2013), http://www.mintz.com/newsletter/2013/Advisories
97. SOLIS, supra note 91, at 22.
98. Emp. Benefits Sec. Admin., FAQs About Affordable Care Act Implementation (Part
XVII) and Mental Health Parity Implementation, U.S. DEP’T OF LABOR (Nov. 8, 2013),
99. Substance Abuse & Mental Health Servs. Admin., Mental Health Parity and Addiction Equity Act (MHPAEA),, http://beta.samhsa.gov/health-financing/implementation-mental-health-parity-addiction-equity-act (last updated Sept. 24, 2014).
100. Id. (state insurance commissioners are also responsible for monitoring fully-insured large group plans).
103. Final Rules Under the Paul Wellstone and Pete Domenici Mental Health Parity and
Addiction Equity Act of 2008; Technical Amendment to External Review for Multi-State
Plan Program; Final Rule, 78 Fed. Reg. 68240,68240 (Nov. 13, 2013) (to be codified at 45
C.F.R. pts. 146 and 147), available at http://www.gpo.gov/fdsys/pkg/FR-2013-11-
13/pdf/2013-27086.pdf [hereinafter Final Rules].