Section 203 of the Consolidated Appropriations Act (CAA), which became law on December 27, 2020, requires group health plans to evaluate compliance with the existing rules governing nonquantitative treatment limitations (NQTLs) under the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
The MHPAEA requires group health plans that apply NQTLs to mental health or substance use disorder (MH/SUD) benefits to ensure that the NQTLs are comparable to and applied no more stringently than the NQTLs applied to medical or surgical benefits (M/S).
Under the CAA, plans are required to “perform and document comparative analyses of the design and application of NQTLs.” The comparative analyses must demonstrate “that the processes, strategies, evidentiary standards, and other factors used to apply the NQTLs to MH/SUD benefits, as written and in operation, are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, and other factors used to apply the NQTLs to medical or surgical benefits in the benefits classification.”
As of February 10, 2021, group health plans are required to make this compliance documentation available to the DOL, HHS, or applicable state authorities upon request. If a group health plan’s analyses does not demonstrate adequate compliance, the plan is provided with a 45-day correction period in which to become compliant by proposing certain actions or providing additional data. If the plan is still found to be noncompliant by the DOL, the plan must inform participants that the plan does not comply. In addition, the DOL will identify noncompliant plans in its annual report to Congress.
The CAA also requires the DOL, HHS, and the Treasury to issue additional guidance on MHPAEA compliance within 18 months of enactment (late June 2022). In the absence of such guidance, plan sponsors that rely on their third-party administrators or insurance carriers to establish and implement NQTLs should inquire what they are doing to prepare for Section 203 compliance.
HBL has experience in all areas of benefits and employment law, offering a comprehensive solution to all your business benefits and HR/employment needs. We help ensure you are in compliance with the complex requirements of ERISA and the IRS code, as well as those laws that impact you and your employees. Together, we reduce your exposure to potential legal or financial penalties. Learn more by calling 678-439-6236.