Compliance News | November 5, 2020
Enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA) continues and has been highlighted as a federal priority in recent reports released by the DOL and HHS. Recently, those departments published the final version of a tool that is intended to help plan sponsors self-evaluate their compliance with MHPAEA.
The tool particularly focuses on the parity rules related to nonquantitative treatment limitations (NQTLs). NQTLs refer to benefit-management techniques such as prior-authorization requirements, determinations that a treatment is experimental, methods for reimbursing providers, step-therapy protocols and restrictions based on geographic location or facility type.
Notably, the additions to the tool include:
Numerous revised and additional examples are provided in the body and appendix of the tool. Some examples revisit issues addressed in prior guidance, while others provide new insights on the application of MHPAEA’s NQTL rules.
The examples were finalized based on the proposal with only minor modifications and clarifications. For more details about the proposal, see our June 22, 2020 article.
The tool also includes a resource intended to assist plan sponsors in comparing provider reimbursement rates for medical/surgical benefits and mental health/substance use disorder (MH/SUD) benefits.
In the final version of the tool, the departments published a nonexhaustive list that showcases the high degree and complexity of information that the DOL may ask a plan sponsor to provide in a federal audit to support its parity compliance. Information that may be requested includes:
The departments are encouraging plan sponsors to implement internal parity compliance plans that promote the prevention, detection and resolution of potential MHPAEA violations.
The tool suggests that an internal compliance plan should cover:
Expectations for group health plan sponsors regarding mental health parity continue to heighten. The tool makes it clear that the departments expect plan sponsors to perform MHPAEA assessments and carefully monitor and document parity compliance.
Many plans rely on third-party administrators and utilization-management companies to administer medical management processes that are NQTLs under MHPAEA. Plan sponsors will need to work closely with administrators to ensure parity compliance is achieved and documented.
Plan sponsors should develop formal, internal parity compliance plans that take into account all aspects of parity compliance.
This page is for informational purposes only and does not constitute legal, tax or investment advice. You are encouraged to discuss the issues raised here with your legal, tax and other advisors before determining how the issues apply to your specific situations.
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