New Law Requires Health Plans to Demonstrate Compliance with Parity Requirements Between Mental Health and Medical Benefits

Beginning February 10, 2021, the U.S. Departments of Labor ("DOL"), Treasury, and/or Health and Human Services ("HHS") (collectively, the "Departments") may request employer-sponsored group health plans to provide evidence that their plans apply limitations on mental health and substance use disorder ("MH/SUD") benefits in parity with those they apply to medical/surgical ("M/S") benefits. [...]adequate compliance with the MHPAEA's NQTL requirements has been elusive, in part due to a lack of clear guidance from regulators on how plan sponsors and administrators can take steps to ensure compliance. Since the issuance of the regulations, the Departments published subregulatory guidance that emphasized the importance of compliance with the parity requirements.1 Recognizing the difficulty health plans experience complying with NQTL requirements, the recent focus has been on subregulatory guidance on NQTLs. In addition to the documented comparative analyses, the Secretary may request: * The terms of the plan containing the NQTL and MH/SUD and M/S benefits to which the limits apply; * Factors used to determine that the NQTL will apply to the benefits; * Evidentiary standards and other sources and evidence used to identify the factors described above; * Comparative analyses demonstrating that processes, strategies, evidentiary standards, and other factors used to apply the NQTLs to MH/SUD benefits are comparable and applied no more stringently than those used in applying the NQTLs to medical/ surgical benefits; and * Disclosure of the specific findings and conclusions that indicate the plan is in compliance with the NQTL parity requirements. In that regard, sponsors and administrators should consider taking the following steps: * Conduct an initial review of quantitative treatment limitations to determine whether any parity compliance issues are apparent on the face of the plan design. * Sponsors and administrators with fully-insured health plans should reach out to their insurance carriers and request a copy of the most recent quantitative and NQTL comparative analyses. * Sponsors and administrators with self-insured health plans should work with their third-party administrators to conduct comparative analyses.