The Consolidated Appropriations Act, 2021 (the "CAA") was signed into law on December 27, 2020. The CAA imposes a substantial new requirement that a group health plan perform and document its compliance with the Mental Health Parity and Addiction Equity Act ("MHPAEA"). Specifically, group health plans must generate a comparative analysis of the plan's mental health, substance use disorder ("MH/SUD"), and medical/surgery ("M/S") nonquantitative treatment limitations to demonstrate the plan does not impose less favorable benefit limitations on MH/SUD treatments. As of February 10, 2021, group health plans are required to produce the comparative analysis to state regulators, federal regulators, and participants upon request.
The MHPAEA provides that financial requirements (i.e., quantitative treatment limits), such as coinsurance and copays, cannot be more restrictive or applied in such a way that makes it more difficult for participants to receive treatment for MH/SUD than M/S benefits. The same requirements exist for nonquantitative treatment limitations ("NQTLs") such as prior authorization, step therapies, or distance standards. Ensuring that NQTLs are not being improperly applied with respect to MH/SUD is an inherently more difficult endeavor than measuring a quantitative treatment; a copayment obligation is readily, and easily, measured and compared. If the MH/SUD copay is more expensive than the M/S copay, it is simple to determine that an impermissible benefit...
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