DOL and HHS FAQs Provide Important Insights
We previously blogged about the new Mental Health Parity and Addiction Equity Act (MHPAEA) reporting and disclosure requirements established by the Consolidated Appropriation Act, 2021 (CAA). As a refresher, employers and carriers that sponsor group health plans are now required to provide upon request a full analysis of the process followed by the plan in establishing non-quantitative treatment limitations (NQTLs) for the plan and the impact these NQTL’s have on mental health and substance use disorder (MH/SUD) benefits provided by the plan. This disclosure requirement went into effect on February 10, 2021.
These reporting/disclosure requirements focus on ensuring that a group health plan’s NQTLs for MH/SUD benefits are no more restrictive than the plan’s restrictions on medical/surgical benefits. The Department of Labor (DOL) and Health and Human Services (HHS) recently published joint FAQs on the implementation of the new reporting requirement.
These joint FAQ clarified the purpose of the MHPAEA disclosure, and who could be entitled to access to the disclosure.
- Plans that contain NQTLs applicable to MH/SUD benefits should not simply wait until the report is requested by the DOL or HHS to prepare the report.
- States, individual participants and participant representatives such as a health care providers may request the plan’s MHPAEA disclosure report as part of an ERISA document request.
- The DOL and HHS will share the information they collect from a group health plan with the state in which the group health plan resides and/or the state in which the carrier is licensed to operate.
- The DOL and HHS will initially focus on the following NQTLs.
- Prior authorization for inpatient services
- Impact of in-network v. out-of-network services on inpatient and outpatient services
- Standards for provider admission to participate in a network
- Out-of-network reimbursement rates (i.e., a plan methods for determining usual, customary and reasonable charges)
Employers should be working with their TPAs and carriers to determine who will be preparing the NQTL disclosures and who will be responsible for their content and accuracy. Further, the joint FAQs make clear that the report will be available to participants and in some cases health care providers. Employers should consult with counsel and be prepared to provide the report to plan participants and heath care providers as necessary to comply with the ERISA document request requirements. We feel this requirement places an even greater burden on the employer to review and monitor the content of the report.
Watch for our next MHPAEA blog that will provide guidance on how employers should structure and prepare for the MHPAEA disclosure.