The U.S. Department of Labor (DOL), the U.S. Department of Health and Human Services (HHS), and the U.S. Department of Treasury have issued their second MHPAEA Comparative Analysis Report to Congress. This report is a requirement of the Consolidated Appropriations Act, 2021 (CAA, 2021) and the Mental Health Parity and Addiction Equity Act (MHPAEA).
Under the CAA, 2021, health plans and insurers imposing nonquantitative treatment limitations (NQTLs) on benefits for mental health or substance use disorder (MH/SUD) treatment must complete comparative reports of the design and application of their NQTLs. They also must annually report those results to Congress.
The congressional report noted common deficiencies in the mandatory comparative analysis reports from health plans and insurers that were required to be completed by February 2021. According to the report, despite being required to do so many plans and insurers could not provide the requested comparative analyses, and even when they did, their analyses were deficient in some respects. For instance, comparative analysis reports lacked the required content, failed to explain the factors used to apply NQTLs adequately, and contained insufficient data.
During the period covered by the report, the DOL issued twenty-five requests for comparative analyses from plans and insurers, which resulted in the issuance of twenty-two initial determination letters and three final determinations of MHPAEA violations. Since April 2021, the DOL has sent 182 letters requesting comparative analyses for more than 450 NQTLs. The CMS also issued five final determinations of MHPAEA violations. The report identified all plans and insurers that received determinations of noncompliance.
According to the report, action by the DOL and the CMS resulted in changes to 135 NQTLs and access to NQTLs for more than four million plan participants and beneficiaries in over 39,000 plans.
The DOL’s Employee Benefits Security Administration (EBSA) and HHS’s Centers for Medicare & Medicaid Services (CMS) also issued a Fact Sheet – FY 2022 MHPAEA Enforcement, which details the enforcement actions those two agencies took during FY 2022.
The DOL and CMS closed 158 investigations during fiscal year 2022 and cited twenty-five violations. The Fact Sheet explains in detail how the agencies perform MHPAEA enforcement activities. Common violations included plans that imposed preauthorization requirements for all MH/SUD benefits but only for some medical/surgical benefits and excluding coverage for all MH/SUD residential treatment but having no comparable coverage exclusion for medical/surgical treatment. Another common violation involved plans limiting benefits for nutritional counseling for MH/SUD conditions but not for diabetes, a medical/surgical condition.
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