Hey friends! We hope the dregs of winter are treating you well! Personally, we are a bit tired of the “wintery mix” of precipitation plaguing the Northeast and are eagerly awaiting the moment when our yards start sprouting crocuses instead of slush. Bitter cold days do lend themselves to curling up to read though, and because we are your nerdy friends, it should come as no surprise that one of our most anticipated reads in recent weeks was the 2022 MHPAEA Report to Congress.
Now, the two of us are obsessed with mental health parity compliance – we’ve spent the better part of the past year helping employers, brokers, third-party administrators, and health insurance issuers navigate the process. However, for those of you who do not fall asleep thinking about the best ways to test operational stringency, here’s a little refresher.
The Consolidated Appropriations Act of 2021 (CAA) amended the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) to provide new protections for health plan participants. The law includes MHPAEA compliance responsibilities for group health sponsors and individual and group health insurers offering both medical/surgical (M/S) and mental health/substance use disorder (MH/SUD) coverage. As of February 10, 2021, all plans must perform, document, and maintain comparative analyses of the design and application of all of their non-quantitative treatment limitations (NQTLs) that apply to M/S and/or MH/SUD conditions and services. The report must examine all NQTLs both as written in plan documents and in operation based on current data.
Translation – every group plan sponsor is supposed to create a report documenting their MHPAEA compliance. Jen likes to call this a Congressionally-mandated book report – and, in many ways, this documentation requirement is unique because it’s about evaluating how a plan is complying with preexisting law that technically hasn’t changed.
Employer groups especially need to analyze all the non-numerical limitations their plan may put on access to care and services. Think prior authorization requirements, network composition, the types of drugs included on the formulary, specific requirements for different types of facilities, how the plan credentials providers, and more. The report needs to include information from the plan’s current ERISA documents and vendor policies. Plus, it needs to have current operational data showing how written procedures play out in real life. The deadline for a plan to prepare its first report was LAST February 10th, not this week’s February 10th!
If a group ignores this requirement, not only can they be fined heavily and subject to litigation from plan participants, they also risk being called out by name in an annual report to Congress. The federal Departments of Health and Human Services, Labor, and Treasury issued their first report to Congress on January 27, 2022, detailing group health plan compliance with the mental health parity law. The good news is that this year, they did not call any employer by name for non-compliance, but only because they are still in the process of working with groups about corrective action. Should any of the more than 200 reviews they have in process result in a final determination of non-compliance, it will be included in next year’s report to Congress.
The report makes it clear that all the employers and health insurance issuers subject to audits during the past year have a lot to work on when it comes to MHPAEA compliance. But, the other good news is that the report also tells us what not to do, both when designing and applying NQTLs to a plan and when preparing NQTL comparative analyses. Here’s what the report taught us:
The final thing we learned when reading this report, we also consider to be good news. It is that the processes MZQ Consulting are engaging in to prepare NQTL reports are right on target. Believe us, friends, we know how much information we’ve been asking for, and how hard it can be to compile the needed data to complete them — but, the Departments mean business here, and we do too.
So, while we cannot control if a plan was not operating in compliance before they come to us for an analysis, we can control what we put into our product. What MZQ prepares is a comprehensive report that identifies and defines all NQTLs imposed by the plan, including defining all applicable plan terms and outlining how the NQTL applies to all benefits and MHPAEA benefit classifications. Our analyses outline all factors used to develop and apply each NQTL and defines each one of them. We also outline all evidence used to support each factor, including noting the qualifications of all decision-makers. Each report includes meaningful plan-specific stringency tests of all NQTLs both as written and in operation. MZQ makes clear conclusions about the compliance status of each NQTL as applied, and we provide an overall conclusion comprised of both specific findings and recommendations for plan improvement and remediation if need be.
So, friends, if you need any help with NQTL comparative analyses for either your own plan or for a client’s plan, just reach out. We are happy to help both groups under active DOL or HHS audit and groups that simply need to prepare their analyses for plan participants and overall compliance purposes.