The DOL, HHS, and IRS have released their second report (July 2023) to Congress on the agencies’ review of comparative analyses required by the Consolidated Appropriations Act, 2021 (CAA, 2021) and the Mental Health Parity and Addiction Equity Act (MHPAEA).
The CAA, 2021 requires health plans and insurers that impose nonquantitative treatment limitations (NQTLs) on mental health or substance use disorder (MH/SUD) benefits to:
- Perform and document comparative analyses of the NQTLs’ design and application, and to
- Annually report to Congress on the results of their comparative analysis reviews.
The Mental Health Parity and Addiction Equity Act (MHPAEA) requires health plans to provide mental health and substance abuse benefits on substantially the same terms as they provide medical and surgical benefits, which includes parity with respect to non-quantitative treatment limitations (NQTLs).
This generally means that financial requirements and treatment limitations applied to mental health or substance use disorder benefits cannot be more restrictive than the financial requirements and treatment limitations applied to medical and surgical benefits.
The types of limits covered by parity protections include:
- Financial requirements—such as deductibles, copayments, coinsurance, and out-of-pocket limits; and
- Treatment limitations—such as limits on the number of days or visits covered, or other limits on the scope or duration of treatment (for example, being required to get prior authorization).
As of February 10, 2021, every health plan needs to have a detailed analysis on-hand to show how they meet these requirements. To make things even more complicated, the DOL is now required to audit these analyses and, along with the HHS, must issue an annual report to Congress detailing the results of these reviews, including the names of noncompliant plans.
At the NAIC (National Association of Insurance Commissioners) 2023 Summer National Meeting in Seattle, August 12-16, the Mental Health Parity and Addiction Equity Act (MHPAEA) (B) Working Group, NAIC Members, State Insurance Regulators, and Interested Parties will meet in open session and in regulator-to-regulator session, pursuant to paragraph 3 (specific companies, entities or individuals) of the NAIC Policy Statement on Open Meetings, to continue the discussion of its work to provide additional compliance tools for the states in determining MHPAEA plan compliance, particularly related to non-quantitative treatment limitations (NQTLs).
Here at SAEBHC in New York City, we are a Parity Team of three who specialize in behavioral health clinical matters, operations, and policy related to the implementation of the Federal Parity Act.
For more than ten years now, we have already been assessing parity compliance that includes comparative analyses of the processes, strategies, and evidentiary standards of NQTLs, including network adequacy as written and in operation, among other areas. As a result, we have honed an efficient and effective methodology for obtaining the data needed in a usable form and conducting thorough assessments of clinical guidelines used to determine medical necessity, claim, preauthorization, grievances, and appeals data.
At a minimum, we are happy to share our methodologies with you and to collaborate or provide technical assistance, where necessary, to help with your efforts to assess parity and resolve violations. Our broad clientele include Attorneys General and health plans with large and small memberships across the country.
Please feel free to contact us for assistance.
Maria Messina, PhD
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WHO WE ARE
We are a behavioral health consulting firm providing solution tools that help provider agencies implement changes to emerging critical issues, overcome operational barriers, ensure improved patient care outcomes, and maximize reimbursement.
We do this by working closely with the agency’s executive team to stay innovative, increase resources, and operationalize cost-effective strategies and programs on behalf of the most vulnerable populations of focus.
Our clients include behavioral health providers, health care systems, state departments of mental health, state departments of substance abuse, children’s services, child welfare agencies, county and municipality departments, school systems, first responders and law enforcement, specialty or therapeutic courts, federally qualified health centers, rural community health/behavioral health providers, and housing and homeless services.
In short, we help you help your communities to thrive.
