Updated: May 4
The Consolidated Appropriations Act of 2021 added several provisions related to transparency in group health plan coverage, including compliance with mental health parity laws.
Specifically, group health plans will have to perform an annual comparative analysis of non-quantitative treatment limitations that apply to mental health and substance use disorder treatments.
At a high level, mental health parity says that if a group health plan covers medical/surgical benefits also covers either mental health or substance use disorder benefits, the plan may be subject to the requirements under the Mental Health Parity Act (MHPA) and the Mental Health Parity and Addiction Equity Act (MHPAEA). In other words, these rules don’t mandate that mental health or substance use treatments be covered, but instead says that if they are covered then they must be covered in the same manner as medical and surgical benefits.
Plans that are subject to these requirements will be subject to three different mandates:
Annual or Lifetime Limits. Group health plans that apply annual or lifetime dollar limits for medical/surgical benefits must generally apply those same (or higher) dollar limits for mental health benefits and substance use disorder benefits.
Parity as to Financial Requirements and Quantitative Treatment Limitations. Plans must also provide uniformity between medical/surgical benefits, and mental health or substance use disorder benefits as to financial requirements (e.g., deductibles, copays, coinsurance, and out-of-pocket maximums) and quantitative treatment limitations (e.g., number of treatments, visits, or days of coverage).
Parity as to Non-quantitative Treatment Limitations. Plans also must comply with other requirements for non-quantitative treatment limitations (e.g., medical management standards, excluding benefits based on medical necessity or medical appropriateness, non-uniform preauthorization requirements).
The Department of Labor, Treasury and HHS are tasked with developing a reporting process for the information to be submitted and evaluated for compliance, which is expected within the next year and a half. Self-insured plans should take steps now to work with the TPA or carrier to ensure NQTLs for mental health/substance use disorder benefits are in parity with covered medical/surgical benefits.