In response to recent developments in legal guidance, health plans are advised to take several specific measures. The Consolidated Appropriations Act, 2021 (CAA) has added an obligation for health plans to record their compliance with nonquantitative treatment limitations (NQTLs) under the Mental Health Parity and Addiction Equity Act (MHPAEA).
NQTLs are limits that are not based on dollar amounts or numerical values, but instead on factors such as medical necessity or prior authorization requirements, standards for in-network provider admission, formulary design, and step-therapy protocols, among other things. The MHPAEA, in general, mandates that NQTLs applicable to mental health and substance use disorder (MH/SUD) benefits cannot be more restrictive than the predominant NQTLs that apply to substantially all medical and surgical (med/surg) benefits.
Considering these stipulations, there are several steps that health plans should implement immediately to stay in alignment with these new guidelines:
- Establish a comprehensive NQTL inventory, listing all NQTLs currently in use.
- For each NQTL, document: its reasons for applying, how it is defined and applied (including non-written or informal applications), the med/surg benefits it applies to, and the comparability between how it is applied to med/surg benefits and MH/SUD benefits.
- Keep detailed records of their MHPAEA comparative analysis, including their methods for assessing NQTLs and their rationale for any differences between how the NQTL is applied to MH/SUD benefits and med/surg benefits.
- Ensure that they have written procedures and standards for applying nonquantitative treatment limitations.
- Review, enhance, and document their systems for evaluating their mental health parity, and designate a responsible individual for conducting this evaluation.
These steps will help health plans ensure that they meet the new DOL guidance on mental health parity. These policies are expected to be subject to review by the DOL, and health plans that fail to properly document their NQTLs and MHPAEA comparative analysis could face enforcement actions.
For more detail, please read the original article here.