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MHPAEA Compliance Filings

MHPAEA Compliance Filings

Insurers that offer ACA-compliant major medical plans in the individual and/or small group markets are required to submit filings by February 28, 2022.  All MHPAEA compliance filings must be submitted only in SERFF.  Insurers must submit one filing per company and market.

Compliance Filing Instructions

The MHPAEA Compliance Filing applies only to ACA-compliant major medical plans in the individual and small group markets that were offered in plan year (PY) 2020 and are also to be offered for PY 2022.  Responses should be based on coverage to be offered for PY 2022, unless otherwise indicated.  Information for any Third Party Administrator (TPA), pharmacy or behavioral health benefit manager, or other entity that is used by an issuer to outsource activities considered for MHPAEA compliance must be included in the response.

The department’s goal for the 2022 cycle of MHPAEA compliance filings is to focus more closely on issuers’ comparative analysis demonstrating compliance for two of the most commonly employed NQTLs:  Prior Authorization and Concurrent Review. The department will also continue to require issuers to submit information related to QTLs.

Similar to previous MHPAEA compliance filings, the documents must be accessed (downloaded) for completion directly from SERFF.:

All MHPAEA compliance filings must be submitted only in SERFF.  Filers should carefully review the information provided in the SERFF General Instructions for Ohio to ensure filings are coded and submitted correctly.

Training

Anytime access to recorded issuer training is available by clicking the "MHPAEA Compliance Training" link in the blue "Launch" box (top right on this page).  Slides from the recorded issuer training are available below:

  • MHPAEA Compliance Training Slides

Questions

We encourage you to email any questions you may have to:  MHPAEAComplianceQuestions@insurance.ohio.gov 

FAQs

The department will continue adding FAQs to this webpage.  Be sure to check back regularly!

1:  Are we required to complete the ODI MHPAEA Compliance form and workbook that are provided in SERFF, or can we substitute our existing internal document formats to provide the requested information and analysis for our MHPAEA Compliance filing submission?

The department requires that all Ohio issuers complete the same ODI form and workbook templates for their Ohio MHPAEA Compliance Filings.

2:   Does the Ohio MHPAEA Compliance Filing requirement apply to student health plans?

 At this time, student health plans are not included in the Ohio MHPAEA Compliance Filing process. However, generally, fully insured student health plans are subject to MHPAEA and should have compliant comparative analysis available upon request and may be included in the Ohio MHPAEA Compliance Filing process for future filing cycles.

3:  Does the Ohio MHPAEA Compliance Filing requirement apply to self-insured MEWAs?

At this time, self-insured MEWA plans are not included in the Ohio MHPAEA Compliance Filing process.  However, certain self-funded MEWA plans are subject to MHPAEA and generally should have compliant comparative analysis available upon request and may be included in the Ohio MHPAEA Compliance Filing process for future filing cycles.

4:  Why is 2020 claim data used for the NQTL analysis? 

Our goal is to analyze data that best represents fully processed claims.

5:  Should prescription drug information be included in the MHPAEA compliance analysis reporting?

 For this compliance cycle, prescription drug is not a category for NQTL analysis data metrics reporting in the MHPAEA Compliance Workbook (Excel file).   However, PY 2022 prescription drug coverage information is required for completion of the QTL metrics section of the workbook and the NQTL comparative analyses section (pdf document, section 3).

6:   How should we define "first level request" and "second level review" in completing the the MH, SUD, and Med/Surg tabs of the MHPAEA Compliance Workbook?

“First level request” means an initial or first time request for the prior authorization/pre-approval of coverage for a requested service.  

“Second level review” indicates that an initial or first time request for prior authorization/pre-approval was not approved or denied, and the request requires an additional, or second level of review, in order to make a determination of approval or denial.

7:   Are plans to pull 2020 data by date of service, or by the Prior Authorization decision date in 2020?

Issuers should pull 2020 data by date of service.

8:   How are the inpatient facilities classified in the MHPAEA Compliance Workbook?  Is it based on state licensure or can the plan apply their criteria?

The parity rules allow plans/issuers to use their own criteria for assigning benefits into classifications, including inpatient, as long as they use the same standards for assignment of both MH/SUD and medical/surgical.

Background Information

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and implementing guidance generally require that financial requirements and treatment limitations (QTL) imposed on mental health or substance use disorder (MH/SUD) benefits cannot be more restrictive than the predominant financial requirements and treatment limitations that apply to substantially all medical/surgical benefits in a classification.

Group health plans and health insurance issuers are also prohibited from imposing non-quantitative treatment limitations (NQTL) with respect to a MH/SUD benefit in any classification unless, under the terms of the plan (or health insurance coverage) as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to MH/SUD benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation to medical/surgical benefits in the same classification.

The MHPAEA Compliance Filing closely tracks recent guidance (FAQ 45) issued by the Departments of Labor, Health and Human Services, and the Treasury in response to amendments made to MHPAEA by the Consolidated Appropriations Act, 2021. Issuers are required to perform and document comparative analyses of the design and application of NQTLs.

Issuers must additionally ensure compliance with all requirements of MHPAEA and may wish to reference additional self-compliance tools and information here: Self-Compliance Tool for the Mental Health Parity and Addiction Equity Act (MHPAEA) (dol.gov).