Expand parity compliance analysis requirements

Non-Quantitative Treatment Limitations (NQTLs) are non-numerical limitations or restrictions to an insurance benefit’s scope or duration (e.g., prior authorization, step therapy, medical necessity exclusions).[1][2] The Mental Health Parity and Addiction Equity Act (MHPAEA) requires that an NQTL applied to mental health/substance use disorder benefits be comparable and not more restrictive than the same NQTL applied to medical/surgical benefits.[1][2][3] The Consolidated Appropriations Act of 2021 (CAA) amended MHPAEA to require most individual and group health plans to perform analyses demonstrating their compliance with MHPAEA.[2][4][5] These analyses must be submitted to the Secretaries of Health and Human Services (HHS), Labor (DOL), or Treasury, as well as any applicable state regulator, upon request.[2][4][5]

While this is important progress toward ensuring the parity compliance envisioned by the implementation of the MHPAEA, the CAA currently applies to individual and group health plans but not Medicaid, leaving tens of millions of Americans without important protections relating to MHPAEA compliance.[6][7][8] Applying the CAA requirements to Medicaid, CHIP, and alternative benefit plans is particularly important given that these plans serve disproportionately low-income populations and people of color.[7]