Anjali N.C. Downs, Kevin Malone, and David Shillcutt, attorneys in the Health Care & Life Sciences practice, in the firm’s Washington, DC, office, co-authored an article in Compliance Today, titled “Best Practices for Mental Health Parity: Considerations for Implementation.”

Following is an excerpt (see below to download the full version in PDF format):

On December 27, 2020, deep within the lengthy Consolidated Appropriations Act (CAA), Congress enacted additional compliance and oversight requirements for group health plans and health insurers (plans and insurers) (referred to as the Strengthening Parity in Mental Health and Substance Use Disorder Benefits Act). The purpose of these new requirements is to codify existing subregulatory guidance regarding certain requirements for compliance programs under the Mental Health Parity and Addiction Equity Act (MHPAEA).Since its passage in 2008, MHPAEA has required health plans and insurers to ensure that beneficiaries have access to benefits that are designed and delivered in a manner that does not discriminate against individuals with mental health conditions or substance use disorders. The new requirements in the CAA provide further specificity as to the types of documentation and comparative analysis that are required for plans and insurers to demonstrate that their nonquantitative treatment limitations (NQTLs) are nondiscriminatory. NQTLs include a very broad range of managed care practices, including medical necessity criteria and clinical coverage guideline development, utilization management, provider network recruitment and reimbursement rate methodologies, and other practices that constitute a limit on the scope or duration of services. The CAA mandates a step-wise NQTL compliance approach that essentially mirrors and codifies the guidance in the U.S. Department of Labor (DOL) Self-Compliance Tool. To comply with these step-wise NQTL compliance requirements, plans and insurers need to develop and maintain detailed documentation about the processes, strategies, and evidentiary standards they rely upon in the implementation of these NQTLs.

While these requirements specific to NQTLs are unique to MHPAEA, the associated documentation and comparative analyses activities should feel familiar because they mirror some of the traditional documentation and auditing and monitoring functions of a corporate compliance program. Ultimately, plans and insurers need to demonstrate, upon request, that they are continually maintaining compliance with regard to parity—in effect maintaining the capacity to rebut a presumption of noncompliance at any time. This includes auditing and monitoring factors used to determine and apply the NQTLs for mental health/substance use disorder services to demonstrate that they are comparable and no more stringent than those for medical/surgical services in the same classification. Moreover, when noncompliance is identified, the plan or insurer has a system to proactively implement corrective action.

Copyright [2021] Compliance Today, a publication of the Health Care Compliance Association (HCCA).

Jump to Page

Privacy Preference Center

When you visit any website, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalized web experience. Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.

Strictly Necessary Cookies

These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms. You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.

Performance Cookies

These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. They help us to know which pages are the most and least popular and see how visitors move around the site. All information these cookies collect is aggregated and therefore anonymous. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.