Wilderness Therapy – Should We Give It Another Look?

1.     What is it?

Wilderness therapy generally is traditional therapy in an outdoor setting that seeks to treat young adults with behavioral or substance use disorders.  Some programs are licensed and accredited and the treatment they provide can be expensive.  It is not uncommon for wilderness therapy to cost $500 per day or over $40,000 in total.

2.     Why should you care?

A participant in your employer-sponsored group health plan might submit a claim for wilderness therapy or request that your plan cover it.  If the terms of your plan exclude wilderness therapy or are ambiguous with respect to its coverage, and if you choose not to cover it, the participant might argue that your plan violates the Mental Health Parity Act of 1996 (MHPA) and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) (collectively, “Federal Mental Health Parity Law”).

As a reminder, Federal Mental Health Parity Law does not require a group health plan to cover mental health or substance use disorder benefits.  However, if a plan provides these benefits, it must provide coverage that is in parity with the medical and surgical benefits the plan provides.  This means, among other things, that a group health plan may not impose nonquantitative treatment limitations (“NQTLs”) for mental health or substance use disorder benefits in any classification unless certain conditions are met.  Mainly, any processes, strategies, evidentiary standards, or other factors used to apply the NQTL to mental health or substance use disorder benefits must be comparable to (and applied no more stringently than) those that are used to apply the NQTL to medical/surgical benefits within the same classification.  If, for example, a group health plan excludes wilderness therapy because of the facility type or because it is experimental or investigative, that would be a NQTL and the group health plan must ensure that the above requirement has been met.

3.     What should you do?

Although wilderness therapy litigation has increased over the last few years, the courts have not yet worked out whether, or when, Federal Mental Health Parity Law requires a group health plan to cover wilderness therapy.  Despite this uncertainty, employers may consider taking some steps to prepare for a potential claim or a request for coverage.

For example, employers may want to:

  • Review their plan to determine whether it covers or excludes wilderness therapy (it may not be clear).
  • If their plan imposes a NQTL on wilderness therapy, identify what processes, strategies, evidentiary standards, or other factors the plan uses to apply the NQTL, and then further analyze whether it similarly applies such processes, strategies, evidentiary standards, or other factors to medical/surgical benefits in the classification.
  • Research wilderness therapy and consider whether to further evaluate their plan’s treatment of this benefit.
  • Obtain benchmarking data to determine whether other employers cover or exclude wilderness therapy under their plans.
  • Amend their plan to cover or exclude wilderness therapy or, if the plan terms are unclear, clarify whether the plan covers wilderness therapy and the terms of such coverage.

Understandably, some employers may want to hold off making changes for wilderness therapy until more cases make their way through the courts or until additional guidance is issued.  Although a wait-and-see approach has its benefits, employers should be prepared to act quickly in the event a participant submits a claim or request for benefits or a group health plan is audited.

This entry was posted in Employee Benefits, Health & Welfare Plans, Health Care Reform and tagged , , , , .

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