News + Insights

The U.S. Department of Labor (DOL) prioritizes enforcement of the Mental Health Parity and Addiction Equity Act’s requirements for nonquantitative treatment limitations (NQTLs). The following are examples of NQTL investigations where the DOL worked with the health plan to quickly resolve any issues and end the investigation:

A network adequacy parity concern was voluntarily resolved through a demonstration of proactive measures and ongoing monitoring practices.

Corrective actions included increasing telehealth, expanding gap policies, expanding monitoring using more robust data, and increasing recruitment efforts for mental health and substance use disorder (MH/SUD) providers.

A preauthorization auto-approval system that was previously only offered for M/S services, and not MH/SUD services, was revised to include MH/SUD services.

An exclusion of medications to treat opioid use disorder was corrected voluntarily.

Corrective actions included removing the exclusion both prospectively and retroactively and offering an opportunity to resubmit claims to participants po-tentially affected by the exclusion.

An age limit on ABA therapy to treat autism spectrum disorder, where there was no similar age limit for M/S services, was removed voluntarily.

Corrective actions included revising plan docu-ments and administrative practices, sending notices to participants and reprocessing affected claims.

Blanket preauthorization on MH/SUD services, and not medical or surgical (M/S) services, was addressed voluntarily.

Corrective actions included decreasing the number of MH/SUD services subject to preauthorization based on the application of a comparable and no more stringently applied standard, and distributing notices and disclosures to partici-pants informing them of the change.

An applied behavioral analysis (ABA) ther-apy exclusion to treat autism spectrum dis-order, where there was no similar treatment exclusion for M/S services, was corrected.

Corrective actions included removing the exclusion both prospectively and retroactively, and offering an opportunity to resubmit claims to participants potentially affected by the exclusion.

A drug testing limit that applied only to MH/SUD services was removed at the service provider level.

Corrective actions at the service provider level included adopting new internal procedures for handling drug testing claims and distributing a notice to participants notifying them of the removal of the limitation. Because the issue was corrected at the service provider level, the DOL did not need to open additional cases on the individual health plan clients.