On December 27, 2020, Congress enacted the Appropriations Act, which included several provisions that affected Health & Welfare Plans. One of those provisions required Health Plan to perform an analysis of the Plan’s “Non-Quantitative” Treatment Limits (“NQTLs”). NQTLs are rules, limits, or restrictions on coverage that are cannot be counted; such as rules on prior authorization, standards for admitting providers to the network, and the classification of treatments as experimental.
The new requirement did not change these rules. Plans must still ensure that NQTLs placed on mental health treatment are comparable to those placed on physical treatment. However, this analysis must now be documented and provided to the DOL upon request. Participants and beneficiaries can also request a copy of the NQTL Analysis. The Appropriations Act required plans to have the analysis completed by February 10, 2021.
This timeframe was extremely aggressive, especially considering that the DOL just recently issued updated guidance on how to conduct the analysis. However, since the underlying laws were not changed, plans that have been monitoring compliance and following best practices should be able to conduct the analysis relatively easily. Undoubtedly, this will involve working with vendors to obtain the necessary data.
The new DOL guidance was issued in a Frequently Asked Questions (FAQs) format. A link to the FAQs is provided at the bottom of this article. Essentially, the FAQs continue to point to the DOL’s Self-Compliance Tool, which is updated bi-annually. The DOL indicates that plans which have been using the Self-Compliance tool will be in a “strong position” to conduct the analysis. The Department also makes it clear that the analysis cannot be conclusory, or simply a collection of a large volume of documents. Instead, plans should follow the nine point guidelines set forth in the FAQs. The guidelines are set forth in Q&A 2 and discuss how the analysis should be conducted and documented.
In conclusion, the new requirement does not change the underlying NQTL rules, but it does require plans to review and document compliance. And as noted above, that reviewed should be thorough and not something thrown together at the last minute. Plans that have been following the DOL guidance should not find the analysis too onerous. On the other hand, plans that were not closely monitoring these rules should use this as an opportunity to correct any deficiencies. It is better to discover any compliance gaps now then during a DOL review or through a Participant appeal. Plan Administrator will need to work with the underlying plan vendors to obtain information necessary to complete the analysis.
The FAQs can be found here: https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-45.pdf