On May 2, 2013 the United States District Court in Vermont issued the first ruling in the country on the Mental Health Parity and Addiction Equity Act. While the Court has not yet issued a final decision in the case, the ruling issued earlier established that the plan administrator has the burden to show that any differences in the way MH/SUD benefits are treated from medical care are based upon accepted clinical standards.
The plaintiff argued that the insurer violated the federal parity law by establishing more restrictive utilization review practices for both prior authorizations and concurrent reviews. The defendant filed a motion to dismiss claiming the plaintiff had to prove that the standards used deviated from what was clinically acceptable. The judge disagreed and the case will continue with the burden of proof to prove any more restrictive policies and procedures are justified by clinical standards.