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Don’t Swear Off MHPAEA Compliance for the New Year

By: Kaitlyn MacLeod, Esq.

Mental Health Parity continues to be a priority for DOL compliance – and should be on every plan’s wish list this Holiday Season to have in case the DOL or a plan participant requests for a copy of the plan’s mental health parity comparative analysis.

As background, the goal of the MHPAEA is to ensure group health plans and health insurers do not provide less favorable mental health/substance use disorder (MH/SUD) coverage than they do medical/surgical (M/S) coverage.  To ensure that plans subject to the MHPAEA maintain parity concerning Non-Quantitative Treatment Limitations (NQTL), all processes, strategies, evidentiary standards, or other factors used to establish that NQTL must be applied no more stringently than how the NQTL is applied to M/S benefits in the same classification. Typical NQTLs include utilization reviews, prior authorization, provider credentialing standards, and plan provisions (like medical necessity or experimental/investigative determinations) and exclusions.

Plans cannot impose NQTLs that are more restrictive on MH/SUD benefits than they are on M/S benefits. So, if a plan does not require prior authorization before approving an inpatient hospital stay for a hip replacement, the plan cannot require prior authorization before approving an inpatient psychiatric hospital stay. Outside of that, the MHPAEA also prohibits NQTLs that only apply to MH/SUD coverage.

Every plan is required to produce a Comparative Analysis of their annual claims data and processes associated with NQTLs (though plans should also be reviewing their QTLs as well). The information gathering process in undertaking a comparative analysis is overwhelming, but the analysis that results can pin-point exactly where the plan or vendors need to improve to maintain continued compliance with mental health parity laws.

The process takes a lot of lifting to complete – not just on the Plan Administrator, but also on vendors. The DOL announced that if a group health plan uses MH/SUD vendors or carve-out service providers, the plan must ensure that all combinations of benefits comply with MHPAEA. You can’t just take their word for it.

Plans must obtain necessary documentation to ensure that all combinations of benefits comply with parity requirements. Even once you have that information, you cannot truly know whether something complies with the MHPAEA until you complete a comparative analysis.

Do you think that some of your vendors, like Employee Assistance Programs, are exempt from the MHPAEA? You may need to check again. 

EAP programs are typically a separately packaged employee benefit option that do not fall under the scope of the MHPAEA. However, some EAP programs include access to several “no cost” or “low cost” counseling sessions. We have seen cases where the plan requires participants to take advantage of those EAP visits before accessing other plan-sponsored mental health benefits – along with plans that only provide mental health benefits through an EAP or participants face a penalty. If a plan does require use of EAP in order to access mental health benefits, that would be a NQTL that needs to be part of the plan’s NQTL Comparative Analysis. For this type of vendor, you will need to ask yourself, are there limits just as restrictive for medical/surgical benefits? Or are these requirements solely applied to MH/SUD benefits?

If you need clarity on what vendors can affect the MHPAEA NQTL comparative analysis and how to begin the info gathering process – we can help. Our comparative analysis service completes the MHPAEA comparative analysis for you. While the TPA and/or plan sponsor needs to be actively involved in requesting and gathering the data, we will support you by breaking down the information requests by vendor, supplying you with email request templates, answering questions, and participating in vendor discussions as necessary. At the end, we will compile a report of findings and recommendations for future compliance.

The NQTL Comparative Analysis requirement isn’t going away this Holiday season – remember that plans subject to the MHPAEA are required to always keep their NQTL Comparative Analyses up to date and reflective of their current standards and operational procedures. Have questions on how to begin? Our Consulting team can help – reach out to us at Phia-NQTL@phiagroup.com.