Table S2: MHPAEA Compliant NQTL Models for Carve-in Plans, by Plan Type.
The smaller range of pre-IFR NQTL scenarios is compared here to the larger range of post-IFR NQTL scenarios in terms of how many plans from each pre-IFR scenario went to each post-IFR scenario.
Furthermore, legal efforts to bring parity to behavioral health services have typically not extended to nonquantitative treatment limits, or NQTLs. NQTLs include direct care management provisions such as preauthorization requirements based on medical necessity review or other standards, and penalties for failure to request this prior to admission for treatment.
The IFR extended the original provisions by clarifying that parity also applied to NQTLs. Prior to MHPAEA, Oregon's parity law was the only one that included NQTLs.
In evaluating the impact of MHPAEA on the generosity of BH care benefits, the role of NQTLs is thus of particular interest.
To examine how MHPAEA and its IFR affected NQTLs among commercial "carve-in" plans (where medical and BH benefits are administered within the same plan) and "carve-out" plans (where BH benefits are administered separately from medical benefits), this study uses unique datasets created by Optum, a fully owned subsidiary of UnitedHealth Group.
* A unique dataset created by Optum's parity compliance team, with specific information about NQTLs used by the medical insurers for each carve-out employer.
But NQTLS were only addressed with the IFR, which was issued in early 2010.
NQTLs are governed by a different, more sweeping test.
For example, relying primarily on parity violations in the application of NQTLs, the New York Attorney General (AG) has entered into a series of five settlements since 2014.
The MHPAEA final rule took great care to not mandate specific procedures or results when applying NQTLs stating that "[d]isparate results alone do not mean that the NQTLs in use do not comply..." However, New York has depended on disparity in denial rates as facial evidence of violations of both MHPAEA and the New York State parity law.
Horgan and colleagues compared self-reported 2009 and 2010 data from a nationally representative sample of 939 health plans to determine the early effects of MHPAEA on cost-sharing, QTLs, and NQTLs
. In unadjusted analyses, they found that both BH and medical in-network outpatient copayments were significantly higher in 2010 compared to 2009, but other changes in cost-sharing following parity implementation (e.g., BH coinsurance) were insignificant (Horgan et al.