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MHPAEA Compliance: The Necessity of The NQTL Comparative Analysis

By: Jon Jablon, Esq.

The Mental Health Parity and Addiction Equity Act (MHPAEA) requires health plans to “show their work”  by performing a comprehensive NQTL Comparative Analysis of the group’s health plan, both as written and in operation. At a high level, the MHPAEA does not require health plans to cover treatment for mental health or substance abuse disorders; however if the health plan does opt to offer mental health coverage and substance abuse disorder benefits, the MHPAEA requires that mental health benefits not be more restricted for mental health and substance abuse disorder benefits than benefits provided for medical and surgical benefits within the same benefit tiers. 

What Is NQTL Comparative Analysis Regarding MHPAEA Compliance?

The analysis requirement under MHPAEA applies specifically to Non-Quantitative Treatment Limitations (NQTLs). Simply put, an NQTL is any non-numerical limit on the scope or duration of benefits for treatment. The analysis focuses on the processes, factors, and standards used in determining and applying these types of limitations. Examples of these limitations can include pre-certification requirements, medical necessity management standards, plan exclusions, experimental/investigational provisions, and pharmacy benefit management practices.

In contrast, a quantitative treatment limitation (QTL) is a treatment limitation that is numerical in nature, affecting things like frequency, duration, and quantity. Examples include annual or lifetime day or visit limits. There is a completely separate process, which includes a two-part test to analyze parity of QTLs.

The difficulty with analyzing NQTLs comes from the basis that they are not numerical in nature and, therefore, are more nuanced to review to determine if parity has been achieved. It can be difficult to know what needs to be analyzed, let alone how to analyze it. This is where The Phia Group, with its reputation for client-focused service, knowledge, and industry expertise separates us from the rest.


Requirements of NQTL Comparative Analysis

An NQTL Comparative Analysis comes with requirements that are intended to prevent an insurance plan from imposing limitations that are more restrictive on substance use disorder and mental health benefits than medical or surgical benefits. The following are some general requirements when performing an NQTL Comparative Analysis:

  • Identify limitations: You will need to identify any NQTLs that are imposed on substance use disorder and mental health benefits, such as network adequacy standards, prior authorization requirements, utilization review procedures and medical management techniques.

  • Compare the NQTLs: Conduct a comparison of the NQTLs applied to medical or surgical benefits against the benefits applied to substance use disorder and mental health benefits. Determine whether the limitations create additional barriers or are more stringent.

  • Review the plan's documents: You will want to review the health plan's documents, such as the benefits booklet and Summary Plan Description (SPD). Assess the coverage offered by the plan and the limitations related to the benefits for mental health and substance use disorder.

  • Review the Policies and Procedures of the Plan’s Vendors: Since the plan is not just assessing for written parity compliance, the plan will need to review it’s applicable vendors’ policies and procedures to ensure that is also in parity operationally.

  • Assess the plan's compliance: Evaluate the compliance of the plan with parity requirements. To do so, assess whether the NQTLs meet certain criteria, such as being comparable to the criteria imposed on medical or surgical benefits in terms of duration and scope.

  • Document the analysis process: You will want to document the entire process of the NQTL Comparative Analysis, including the steps you take, your findings and any areas of noncompliance. Keep good records to show compliance efforts, along with the reasoning behind the decisions that are made during the analysis process, especially in the case of an uncooperative vendor.

  • Ensure compliance with regulations:. Once you have completed the NQTL Comparative Analysis, you will need to make changes (if applicable) to the plan’s provisions, policies, and operational procedures to ensure the plan is in compliance with MHPAEA.

Example of an NQTL 

As an example, suppose a health plan were to require treatment plans for both substance use disorder treatment facilities and home health care. Any limitations imposed on mental health/substance use disorder services must be equitable to the restrictions imposed on the same tiers of medical/surgical benefits. In this example, requiring treatment plans for all substance use disorder treatment from one of the only facilities meant to treat substance use disorder affects a wider scope than that of requiring a treatment plan for home health care does. 

It’s the little things like this that can cause the biggest headaches — not necessarily because they’re difficult to determine, but because it can be counterintuitive that they would even constitute non-quantitative treatment limitations in the first place. Leaving them out of the analysis, even accidentally, can cause an analysis to be out of compliance.

The Importance of Having a Completed NQTL Comparative Analysis on File

You may be asking: “What if the regulators or patients never ask us for this analysis, though? Won’t we just have wasted our money?” The short answer is no, you have not wasted your money because one of the two major prongs of the law is to have a “current” analysis on file. This is true whether the status of the report indicates the plan is deficient or satisfactory. 

Additionally, it isn’t just the Department of Labor (DOL) that can request the analysis. Applicable state authorities, plan participants, and even providers are allowed to request a copy of the report, which must be produced. While the regulators certainly don’t plan on spot-checking every health plan, as they don’t have the resources for a large-scale MHPAEA audit, they are required to review at least twenty plans annually. Regulators have been exponentially increasing the amount reviewed since the Consolidated Appropriations Act of 2021 was signed into law. Failure to deliver the analysis to any one of these individuals or entities could leave you in precarious position if a formal compliant has been made to the DOL for lack of doing so. 

Mental Health Parity and NQTL Comparative Analysis

At the end of the day, the most important thing to remember is that this MHPAEA requirement is two-fold. While performing an NQTL Comparative Analysis is one of the requirements, it is equally important that the plan complies with the parity requirements of the MHPAEA. Some of the risks for noncompliance include the plan finding itself on the DOL’s radar for a full audit or potentially noncompliance penalties pending further regulatory guidance. It’s also worth mentioning that performing this analysis is a great way for health plans to find out whether they are truly compliant with the parity aspect of the MHPAEA. 

Why Work with a Consulting Vendor?

A consulting group can help your organization draft an MHPAEA-compliant healthcare plan that's tailored to your organization's unique needs, so you can close coverage gaps and address plan limitations without risking compliance. 

A vendor that combines industry-leading technology with an innovative approach to plan drafting, like The Phia Group, LLC, is your best option. Our client-centric approach enables us to customize plan documents to your specific needs, ensuring uniform coverage across your organization and strengthening your financial security.

Some vendors will also help you perform the NQTL Comparative Analysis so you won't be alone when it comes to navigating MHPAEA compliance. 


Contact Phia Group for Consulting on MHPAEA or Conducting an NQTL Comparative Analysis

At The Phia Group, LLC, our mission is to make health benefits more affordable for both employers and employees through healthcare cost containment techniques. Please don’t hesitate to contact us at The Phia Group, LLC if you need help understanding the MHPAEA or determining whether a given plan is subject to it. 

We also perform NQTL Comparative Analyses if your plan or plans you service need one completed. We’re happy to assist you through the entire process as we understand it can be daunting. For more information or to request a quote for our NQTL Comparative Analysis services, please reach out to us at