Mental Health Benefits – Comparative Analysis of NQTLs

The Mental Health Parity and Addiction Equity Act (MHPAEA) requires parity between a group health plan’s medical/surgical benefits and its mental health or substance use disorder (MH/SUD) benefits. These parity requirements apply to financial requirements and treatment limits for MH/SUD benefits. In addition, any nonquantitative treatment limitations (NQTLs) placed on MH/SUD benefits must comply with MHPAEA’s parity requirements.

Comparative Analysis

The Consolidated Appropriations Act of 2021 (CAA) strengthened MHPAEA’s parity requirements. The CAA requires health plans and health insurance issuers to conduct comparative analyses of the NQTLs used for medical/surgical benefits compared to MH/SUD benefits. This analysis must contain a detailed, written and reasoned explanation of the specific plan terms and practices at issue and include the basis for the plan’s or issuer’s conclusion that the NQTLs comply with MHPAEA.

Plans and issuers must make their comparative analyses available upon request to the Departments of Labor (DOL), Health and Human Services, and the Treasury (Departments) or applicable state authorities. If the Departments find that a plan or issuer is out of compliance, they will specify the corrective actions that must be implemented within 45 days. If the plan or issuer is still not in compliance after those 45 days, the plan or issuer must notify all enrollees of that determination within seven days.

Self-compliance Tool

The DOL maintains an MHPAEA self-compliance tool that includes a section on NQTLs outlining the process for conducting comparative analyses of NQTLs. According to FAQs issued by the Departments, health plans and issuers that have carefully applied the NQTL guidance in the DOL’s MHPAEA self-compliance tool should be in a strong position to comply with the requirement to provide comparative analyses upon request.

Examples of NQTLs

• Medical management standards limiting or excluding benefits based on medical necessity or appropriateness;
• Formulary design for prescription drug benefits;
• Network tier design;
• Prior authorization;
• Out-of-network reimbursement rates; and
• Step therapy protocols.

Action Steps

• Health plans and issuers are required to conduct and document an analysis of NQTLs for MH/SUD benefits.
• Employers with fully insured plans should reach out to their issuers to confirm that this analysis is available.
• Employers with self-insured plans should reach out to their third-party vendors to determine if this analysis has been completed.

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