In December of 2020 Congress passed into law the Consolidated Appropriations Act. This Bill addresses how the DOL, HHS and IRS will assess how well employer plan sponsors and Health Insurance Carriers are keeping up with the compliance requirements under the Mental Health Parity and Addiction Equity Act (MHPAEA).
Plan sponsors must now complete extensive analysis regarding the broad plan limits, Quantitative Treatment Limitations (QTLs) and Non-Quantitative Treatment Limitations (NQTLs) of their plans. Part of the compliance requirements are that each plan sponsor complete a detailed analysis of your plan, both written and in operation. This comparative analysis requires plan sponsors to “show your work” in a very detailed fashion.
The analysis must be performed on all vendors offering services under your plan, not just your TPA. For example this would include your TPA, PBM, networks, utilization review vendors any any other vendor who potentially could play a role in treatment limitations for mental health and substance use disorder benefits. This analysis then must be made available both to plan members upon request and the DOL starting February 10th, 2021.