Ninth Circuit Mandates Stricter Standards for Mental Health Parity
On August 26, 2011, the Ninth Circuit Court of Appeals imposed stricter requirements for ERISA health plans subject to California's Mental Health Parity Act. In Harlick v. Blue Shield of California, ___ F.3d ___ (9th Cir. 2011), the Court held that ERISA health plans subject to California law must cover all "medically necessary treatment" for the nine mental illnesses listed in the Mental Health Parity Act, even if the plan does not cover the same treatment for physical illnesses. In Harlick, the plaintiff sued the medical plan after it refused to cover her treatment for anorexia nervosa at a residential treatment facility. The plan specifically stated that "residential care" was not covered. The Court found that although the medical plan did not require the coverage, the Mental Health Parity Act required the medical plan to cover "all medically necessary treatment." The Court held that the plan was foreclosed from asserting that the plaintiff's residential care was not medically necessary because that assertion was not included as a reason for denial of her claim.
For more information regarding this case, or California’s Mental Health Parity Act in general, please contact your Trust Fund counsel.
Kristina M. Zinnen