Mental health continues to be a hot topic of conversation among HR leaders and health insurance providers. Recently, the Departments of Labor (DOL), Health and Human Services (HHS), and the IRS proposed a rule to amend the existing Mental Health Parity and Addiction Equity Act (MHPAEA).
With the DOL’s recent request for input from Group Health Plans and issuers regarding Nonquantitative Treatment Limitations (NQTLs), companies should prepare. They can anticipate ongoing discussions about how mental health benefits are administered.
Following their proposed rule, the three departments issued their second yearly report to Congress. In it, they examined mental health parity according to the rules of the Consolidated Appropriations Act of 2021 (CAA).
Here are the highlights.
Common Issues With Mental Health Parity
Unfortunately, only a few Group Health Plans did well. Most failed to meet the criteria guaranteeing equal treatment between medical/surgical and mental health benefits. Furthermore, according to numerous comparative analyses, many issuers still needed improvement. This was even after receiving multiple warnings.
Problems with parity concerning mental health benefits could be categorized into six groups.
- Annual dollar limits
- Limits on treatment, such as coverage duration, frequency, visit count, etc.
- Overall lifetime dollar limits
- Financial prerequisites, such as co-payments, coinsurance, deductibles, etc.
- Accumulated financial prerequisites
- Benefits across all categories
Incidentally, this is an excellent checklist for companies to start reviewing their mental health benefits. The goal is to streamline the review process and lessen the burden on health plans. This establishes a data-driven method for assessing whether these limitations comply with the law.
Although few issuers will undergo government audits, they are still required to comply with the rules. Therefore, the evaluation of benefits through an NQTL analysis and adoption of tactics to ensure parity is necessary.
Reviewing Mental Health Benefits
Take the time to review agreements with your plan’s providers. Plans are fiduciaries. That means, as employers, you are responsible for decisions regarding MHPAEA compliance. There are a couple of things to consider as your company reviews its plan design and benefits.
- How successful is the existing language at addressing mental health benefits?
- Do restrictions or limits exist for mental health issues that do not exist for medical/surgical benefits?
As a decision-maker for your company, you should know your plan’s benefits regarding mental health. In fact, you should be capable of explaining them to employees.
Completing an NQTLs Analysis
Conducting an NQTLs analysis is a given. It has been required since February 2021. In the future, group health plans will be required to gather and assess relevant data. At a minimum, that includes data required by state laws regarding NQTLs and details about the number and percentages of denied claims. This helps determine how NQTLs affect access to mental health and substance use disorder benefits.
For ERISA plans, a named fiduciary may certify compliance with the rules and a review of the results. They must verify when the analysis is completed and cooperate with an audit if needed.
If the MHPAEA Proposed Rule is accepted, the new requirements apply to plans beginning January 2025. Until then, companies must continue to comply with the existing MHPAEA and CAA requirements.
In conclusion, carefully reviewing agreements with plan providers is crucial. Take a close look at the agreements you have with plan providers. The employer is held accountable for any mistakes or choices related to compliance with the MHPAEA. That holds true whether the plan is fully insured or self-funded.
For self-funded plans that work with one or more TPAs (Third Party Administrators), schedule time for discussions about benefits. These conversations should help companies to:
- Engage in the necessary actions
- Pose the right questions
- Carry out a thorough analysis
For fully insured plans, pay attention to the specifics. You should thoroughly understand your plan’s mental health benefits so you can explain them to participants.
This proactive approach is essential. It ensures that mental health parity is upheld and participants receive the benefits to which they are entitled.