Old Requirements - New Enforcement

Most plan sponsors are familiar with MHPAEA which originally became law in 2008.  However, very few are familiar with the updates to this law which went into effect on February 10th, 2021.

In December of 2020, an update to this law was passed along with a number of other much more well known change to our healthcare law.  As the marketplace has been focused on new transparency and surprise billing guidelines, the new required Comparative Analysis has been on the back burner.

Unfortunately for plans, the compliance requirement remains nonetheless.  In fact, we are receiving reports of current DOL audits requesting this detailed analysis. 

The DOL is Serious about enforcing compliance

Poor Compliance Audits Led to these New Requirements

During DOL audits over the past few years there has been an increasing focus on health plans to ensure compliance with MHPAEA.  The DOL has reported that their findings were disappointing in that the marketplace had not seemed to implement true parity in the way plans actually operate.

Simply put – they had enough and pressed for additional requirements of a through analysis to be made on all areas of a health plan that can limit coverage for Mental Health and Substance Abuse in a way that is more stringent that regular medical, surgical or pharmacy claims.

As of February 10th, 2021 this analysis is required to be completed.  

In addition to this, plan sponsors must make this analysis, along with other compliance information, available to plan members, the Department of Labor and the HHS.  Enforcement is expected to be swift as this is a major area of focus by the DOL.  

NQLT Examples

Take a look at some examples of NQTLs by clicking below

See Examples