The Consolidated Appropriations Act, 2021 (CAA), the year-end stimulus and budget law enacted on December 27, 2020, includes a requirement for group health plans providing mental health and substance use disorder (MH/SUD) benefits, as well as medical/surgical (M/S) benefits, to formally analyze and compare nonquantitative treatment limitations (NQTLs) between those benefits. The data and results must be reported to the applicable federal agency — either the Department of Labor (DOL)1 or the Department of Health and Human Services (HHS), as appropriate — upon request, within 45 days of the CAA’s enactment. This means the DOL can begin requesting a comparative analysis report from group health plans starting February 10, 2021.
While the Mental Health Parity and Addiction Equity Act (MHPAEA)2 currently requires group health plans to provide parity between MH/SUD and M/S benefits with respect to quantitative financial and treatment limitations (e.g., copays/coinsurance, visit limits, day limits) and NQTLs (e.g., preauthorization requirements, network sufficiency, medical management standards), the CAA has created more formal analyses and reporting requirements.
The NQTL analysis required by the CAA must include the following:
Note that the government regulators must finalize any draft or interim guidance and regulations relating to the NQTL analysis requirements in CAA within 18 months after the date of enactment.
Generally, the DOL can request that a group health plan submit the new NQTL comparative analyses for potential violations of the MHPAEA, complaints regarding NQTL noncompliance and “any other instances in which the DOL determines appropriate.” The CCA also requires the DOL to request no fewer than 20 of the NQTL compliance analyses per year.
The following briefly describes the process under which an NQTL analysis will be reviewed, as set forth in the CAA:
The DOL Secretary must submit a report to Congress on December 20, 2021, with a summary of the comparative analyses received, and then no later than October 1 of each year thereafter. That report, available to the public, will include the group health plans and issuers that are not in compliance with the MHPAEA. Also, the DOL is required to share its findings on whether or not a group health plan is in MHPAEA compliance with the states where the group health plan is located.
Employers should determine whether MHPAEA analysis (including NQTL analysis) has been conducted (and documented) on their group health plans:
It is not yet known whether the DOL will begin reviews before formal implementation guidance is issued. Employers should consult with those knowledgeable in how NQTLs operate in group health plan administration to ensure compliance.
1 The DOL will enforce the provisions for group health plans subject to ERISA.
2 See “Final FAQs issued on nonquantitative treatment limits under MHPAEA,” Insider, September 2019.
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Insider January 2021 | .6 MB |