DOL Initial MHPAEA Enforcement Focus

The Department of Labor DOL has listed enforcement of MHPAEA compliance as a top priority starting in 2021.  It is important to note that the DOL’s goal is compliance, not penalties.  In the DOL audits and reviews to come, they have identified four specific NQTLs that are the highest priority.  This is NOT to say that the entire comparative analysis is not important.  Rather, these items should simply be at the top of the list for analysis:

• Prior authorization requirements for in-network and out-of-network inpatient services
• Concurrent review for in-network and out-of-network inpatient and outpatient services
• Standards for provider admission to a network, including reimbursement rates
• Out-of-network reimbursement rates, including plan methods for determining usual, customary, and reasonable charges.

Plans should still perform and document analyses for all NQTLs imposed.  The initial focus on the four specified NQTLs does not limit the agencies’ authority to request or review different or additional NQTL analyses.