May 19, 2022
The Departments of Labor, Health and Human Services and the Treasury released the 2022 Report to Congress on Compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA). The report includes general information about MHPAEA enforcement and activities related to the comparative analysis requirements that are part of the Consolidated Appropriations Act (CAA).
What you need to know: The report identified several non-quantitative treatment limits (NQTL) that aren’t being applied in parity for mental health/substance use disorder (MH/SUD) benefits. These findings are general observations for all insurers/plans.
For insured groups: We are reviewing our Fully Insured plans to make sure these limits are being properly applied to meet parity requirements.
Insured groups do not need to take any action.
For self-insured groups: We want to make our ASO clients aware of the NQTLs of concern. It’s not a complete list, but these are the limits we’ve identified that might impact ASO plans. As always, we recommend ASO clients consult their own legal counsel.
What to look for: ASO clients may want to review their plan designs to check that these NQTLs meet parity:
- Limits or exclusion of applied behavior analysis therapy or other services to treat autism spectrum disorder
- Limits or exclusion of medication-assisted treatment for opioid use disorder
- Preauthorization or precertification requirements if client-customized*
- Limits or exclusion of nutritional counseling for MH/SUD conditions
- Limits or exclusion of residential care or partial hospitalization to treat MH/SUD conditions
- Exclusion of care for chronic MH/SUD conditions
- Limits or exclusion of speech, occupational or physical therapy to treat MH/SUD conditions
- Requiring evidence of progress to continue covering MH/SUD care
- Discharging members from MH/SUD treatment for failing to show significant improvement
- Discharging members from MH/SUD treatment if the member leaves against medical advice
- Denying coverage of MH/SUD treatment if there’s no certification that the member completed the full continuum of care needed/available
Background: The CAA amended the MHPAEA to require plans and issuers to compare and document how each NQTL is imposed and to provide these analyses upon request by state or federal agencies. These findings are then reported to Congress.
*Blue Cross and Blue Shield of New Mexico has reviewed its standard preauthorization/precertification requirements for parity.