The U.S. Labor Department (DOL) has issued guidance on new implementation requirements for the Mental Health Parity and Addiction Equity Act (MHPAEA) that the 2021 Consolidated Appropriations Act requires.
Enacted on Dec. 27, 2020, the 2021 Consolidated Appropriations Act requires group health plans and health insurance issuers offering group or individual health insurance to perform and document analyses of how they comply with MHPAEA in their application of non-quantitative treatment limits (NQTLs) to mental health/substance use disorder (MH/SUD) benefits, compared with their application of NQTLs to medical/surgical benefits.
As of Feb. 10, 2021, health plans and insurers must make these comparative analyses available upon request to three federal agencies that oversee MHPAEA implementation: DOL, the U.S. Department of Health and Human Services, and the U.S. Treasury Department.
The required NQTL analyses by health plans and insurance issuers must include the following information:
- A description of the NQTL, plan terms, and policies at issue;
- Identification of the MH/SUD and medical/surgical benefits to which the NQTL applies;
- The factors used in applying the NQTLs to MH/SUD benefits and medical or surgical benefits;
- The evidentiary standards used for these factors;
- The comparative analyses demonstrating that the processes, strategies, evidentiary standards, and other factors used to apply the NQTLs to MH/SUD benefits, as written and in operation, are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, and other factors used to apply the NQTLs to medical/surgical benefits in the benefits classification; and
- The specific findings and conclusions reached by the plan or issuer, including any results of the analyses that indicate that the plan or coverage is or is not in compliance with the MHPAEA requirements.
The new law also requires the federal agencies to share findings regarding these analyses of MHPAEA compliance with the state governments where the plans or issuers are located and submit an annual report to Congress on these findings.
The guidance provides additional detail regarding the following topics:
- What information plans and issuers must make available to support their their comparative analyses demonstrating compliance with MHPAEA in their use of NQTLs;
- Examples illustrating when the federal agencies might determine that a comparative analysis of NQTLs is insufficiently specific and detailed;
- The types of documents that plans and issuers should be prepared to make available to the federal agencies to support their analyses and conclusions regarding their NQTL comparative analyses;
- What actions the federal agencies will take if they determine that a plan or issuer has not submitted sufficient information or is not in compliance with MHPAEA;
- Whether state agencies and plan participants and beneficiaries may request to see a plan or issuer’s comparative analysis of its use of NQTLs;
- Which specific NQTLs the federal agencies plan to focus on in the near term when requesting comparative analyses from plans and issuers for review, namely:
- Prior authorization requirements for in-network and out-of-network inpatient services,
- Concurrent review for in-network and out-of-network inpatient and outpatient services,
- Standards for provider admission to participate in a network, including reimbursement rates, and
- Out-of-network reimbursement rates (plan methods for determining usual, customary, and reasonable charges).