Full-spectrum Support to Meet Your Plan’s Mental Health Parity Needs
Our Mental Health Parity compliance experts assist insurers, health plans, ERISA-plan sponsors and third-party administrators. We help organizations assess and remediate current NQTL analyses for deficiencies and risks, develop new NQTL analyses, and assist with responding to regulatory audits and annual reporting.
We have the propriety tools and expertise to help develop and assess:
- MHPAEA applicability
- NQTL documentation compliance
- Comparative analysis of NQTL application
- Disclosure compliance
- MHPAEA compliance oversight, auditing, and monitoring plan
Read About Mental Health Parity NQTL Analyses for Health Plans and ERISA Self-Funded Groups
The Department of Labor (DOL) is actively auditing plans for Mental Health Parity compliance. Plans may need up to 21 different NQTL Comparative Analysis documents to demonstrate that cost-sharing and treatment limits on mental health or substance abuse services are no more restrictive than those for medical or surgical care. Click here for 2021 DOL investigations and enforcement actions. In its 2021 audits, the DOL found that virtually none of the NQTL analyses were sufficient to demonstrate compliance.
ATTAC can evaluate and help you prepare Mental Health Parity NQTL Comparative Analyses and test QTLs. We also help plans develop required polices, procedures and NQTL documentation. These documents must be provided to the DOL and CMS upon request when audited.
Quantitative Treatment Limit (QTL) Testing
Financial requirements (copays, deductibles) and QTLs that apply to mental health and substance-use disorder benefits must be no more restrictive than the predominant financial requirements and treatment limitations that apply to substantially all M/S benefits. Testing should be done every time you change plan cost-sharing or benefits.
ATTAC partners with an industry-leading actuarial firm with extensive MHPAEA experience to perform the QTL substantially-all and predominance testing for each plan offered. The QTL testing evaluates whether plan designs meet the financial restrictions and QTL requirements of MHPAEA regulations and provides opportunities for improvement when needed.
Non-Quantitative Treatment Limitations (NQTL) Compliance & Testing
We assist with reviewing and documenting each NQTL Comparative Analysis within the six benefit classes defined by regulation. ATTAC supports insurers and ERISA self-funded groups through each step of identification, documentation, assessment, evaluation, and remediation of all NQTLs for each plan design. This includes reviewing plan features that may or may not be expressed numerically, but would otherwise impact the scope or duration of the benefit.
Partnering with our Mental Health Parity experts can provide your team with a plan to conquer your NQTL needs. Working with ATTAC saves time and resources as the parity documentation requirements tighten and the enforcement landscape evolves.
Mental Health Parity Proposed Rules: Compliance Just Got More Complex & Costly
Building effective Mental Health Party NQTL comparative analyses has been a challenge from the beginning, and the new proposed regulations will cause most plans to go back to the drawing board to expand and revise their NQTLs.
ATTAC’s Mental Health Parity team has helped plans and issuers of all sizes, including Blues, build or rebuild NQTL analyses to meet compliance requirements.
Establishing an Internal Mental Health Parity Compliance Plan
The requirements and analysis of the NQTLs, QTLs, and other actions needed to comply with MHPAEA and its regulations cause significant risks to health plans and ERISA self-funded groups. A Mental Health Parity Compliance Plan can help prevent, detect, assess, oversee, and mitigate potential noncompliance to avoid enforcement and legal risks.
ATTAC can help your health plan or ASO group establish a MHPAEA compliance plan or enhance your current compliance program to incorporate MHPAEA oversight activities.
See our Mental Health Parity Capabilities Brochure
Contact ATTAC about Mental Health Parity NQTL Analyses Development
Mental Health Parity NQTL Analysis FAQs
What types of organizations are being audited?
The DOL is auditing insurers and employers acting as plan sponsors under ERISA, including testing plans offered by self-funded groups.
What do we need to do to get ready for NQTL?
Plans and employer sponsors must have extensive documentation and detailed analyses of Non-Quantitative Treatment Limitations (NQTLs) comparing their management and application of medical benefits to mental health and substance use disorder benefits. These analyses extend beyond TPAs and include pharmacy benefit administrators and other plan service providers.
Detailed NQTL analyses can be required for up to 21 different areas of each benefit plan.
How do we ensure we have adequate documentation?
Mental Health Parity documentation requirements and enforcement are tightening. ATTAC will help with the time-consuming effort of developing documentation by reviewing each NQTL comparative analysis needed across six benefit classes. We guide plans through each step of identification, evaluation and documentation of NQTLs. We also review TPA-identified NQTLs, provide feedback and identify risks; we can assist with remediation if necessary.
What do we need to include in the analysis? How can ATTAC help?
We’ll help your group prepare each NQTL analysis or review the NQTL documents your plan partners provide. The analysis must:
- Identify and define all NQTLs imposed in six benefit classifications
- Detail how plan terms apply to each benefit classification
- Identify and define all factors and evidentiary standards used to design and apply NQTLs
- Detail process of how NQTLs are applied
- Identify and define factors and processes used to monitor and evaluate the application of the NQTL
- Provide specific findings and conclusions, which include results that indicate the plan or coverage is or is not in compliance with MHPAEA
What information does my plan need to provide to ATTAC? Where do we get the data?
We will partner with you to help you obtain the necessary information from your TPA and/or other vendors.
How long does it take to complete the NQTL analysis?
There are many factors impacting the time needed to complete the analyses, including how long it takes to get documentation from your health plan partners and how complete the information is.
What will our analysis include?
We will provide an NQTL comparative analysis assessment and documentation including requirements which may include prior authorization procedures, network access, provider reimbursement, formulary design, and other relevant NQTLs.
What if we’re audited?
The best situation is to be prepared before the audit. Our Mental Health Parity team will help you prepare and have an audit playbook ready. We can also help you rapidly respond to a DOL audit request, review available NQTLs and pull together information from TPAs and others to make your best presentation to the DOL.
Why should we work with ATTAC Consulting Group?
We’re recognized as a premier national consulting, compliance, and auditing firm serving insurers and ERISA sponsors. Our experienced team performs audits and assessments to evaluate compliance with state and federal laws and regulations. We have deep experience assisting clients in writing complete NQTL analyses and responding to the DOL expectations of an MHPAEA audit.
What is Mental Health Parity
Mental health parity ensures health insurance issuers cover mental health services and substance use disorder (MH/SUD) disorder treatment on the same level as medical and surgical (M/S) services. They primarily seek to eliminate disparities in the coverage of MH/SUD treatments, ensuring patients with mental illness and addiction receive the same benefits as those with physical health conditions. For instance, patients with chronic conditions like diabetes should receive the same care as those with issues like anxiety, depression, and prescription drug addiction.
In the United States, the Mental Health Parity and Addiction Equity Act (MHPAEA), which was enacted in 2008, ensures equal coverage of treatment for mental illness and substance use disorders. Under the law, mental healthcare costs like deductibles, copays, and other out-of-pocket expenses are equal to physical health costs. Additionally, the law seeks to eliminate discriminatory practices on MH/SUD treatment, such as limitations on the number of visits and limited access to in-network mental health specialists like psychologists and therapists.
Key qualities of mental health parity
- Financial Parity: Health insurance plans must provide MH/SUD benefits with financial requirements and treatment limitations that are not more restrictive in scope or degree than those imposed on M/S benefits. For instance, if a health insurance plan charges a $30 copay for a doctor’s appointment, it can’t charge a higher copayment for a therapy session.
- Treatment Limitations Parity: In line with requirements from regulatory bodies and the law, the implementation of Non-Quantitative Treatment Limitations (NQTLs), such as prior authorization, utilization review, and other non-numerical restrictions for MH/SUD benefits, must achieve parity with NQTLs applied to M/S benefits. For instance, accessing in-network mental health specialists like therapists and psychologists should be as simple as accessing other specialists.
Closing the Gap
Achieving parity in mental health coverage is crucial for reducing stigma, bolstering treatment access, and promoting mental well-being. Regulatory bodies and insurance oversight agencies rigorously monitor and enforce compliance with mental parity laws, ensuring fair and equitable coverage for MH/SUD services.
NQTL stands for Non-Quantitative Treatment Limitations and it refers to the restrictions imposed by health insurance plans on mental health and substance use disorder (MH/SUD) benefits. Unlike quantitative treatment limitations (QTLs), which are numerical and impose restrictions on things like visits or copayments, NQTLs are non-numerical. NQTL analysis examines non-quantitative treatment limitations within insurance plans for MH/SUD benefits, assessing scope and duration limitations beyond numerical values.
While NQTLs impact both medical/surgical (M/S) and mental health/substance abuse disorder (MH/SUD) treatment, U.S. federal law primarily focuses on promoting parity in MH/SUD benefits. According to the Mental Health Parity and Addiction Act (MHPAEA), health insurance plans must provide MH/SUD treatment coverage at the same level as M/S treatment, ensuring equal access to both kinds of care.
Examples of NQTLs
- Network Restrictions: Certain health plans limit its members’ access to specialists such as psychologists, psychiatrists, or therapists by requiring them to see only in-network physicians.
- Compensation Rates: The amount that health care providers get paid by insurance companies for the services they give; this has an immediate effect on which treatments are available.
- Step Therapy: Some health plans require patients to look into less expensive, clinically proven treatments before they may receive more expensive options. This ensures that resources are used as efficiently as possible.
Equitable Healthcare Access
NQTL analysis ensures health plans don’t unfairly restrict MH/SUD coverage through NQTLs compared to M/S coverage. If unfair restrictions exist, it could signal a breach of parity laws requiring corrective measures to ensure equitable access to MH/SUD services.
Regulatory bodies and enforcement agencies may use NQTL analysis to enforce corrective measures, ensuring patients receive equitable access to MH/SUD treatments.
