The 2023 Mental Health Parity Report to Congress names eight insurance plans for noncompliance, identifies the DOL’s enforcement priorities, and puts employers on notice that DOL expects better compliance from the start of any audit. The report was released with the proposed mental health parity rules.
Background: Under the Mental Health Parity and Addiction Equity Act, employers are required to ensure that any financial requirements (such as coinsurance and copays) and treatment limitations (such as visit limits) that apply to mental health and substance use disorder (MH/SUD) benefits are no more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits. Employers are also required to perform and document a complex comparative analysis of the design and application of their non-quantitative treatment limitations (NQTLs) to demonstrate parity and provide those analyses to DOL upon request.
Enforcement priorities include prior authorization differences, impermissible exclusions of key treatments (e.g., ABA for autism), network adequacy and admission standards – including reimbursement rates, out-of-network reimbursement rates, concurrent care review differences, provider billing restrictions, exclusion of medication-assisted treatments, and the exclusion of nutritional counseling.
Employers are on notice that going forward DOL expects “more complete comparative analyses from the start of the review process” and will expect any deficiency “to be cured more quickly,” and that it may not provide opportunities to address problems before issuing a final determination of non-compliance.