A Department of Labor Office of the Inspector General report examined the extent to which the Employee Benefits Security Administration (EBSA) enforced compliance with parity non-quantitative treatment limitation (NQTL) laws and requirements.

Reminder:

• NQTLs are benefit limitations imposed by health insurance plans that are not numerical, including prior authorization, concurrent review, step therapy, medical necessity determination, network adequacy, and other policies.
• The Parity Act requires NQTLs used by insurers to be applied comparably to mental health/substance use disorder benefits and medical/surgical benefits. Comparative analyses are used to ensure the plans’ NQTLs comply with that rule.

The main point: The audit found that EBSA lacked critical tools to enforce compliance and deter parity violations, including:

• the authority to assess civil monetary penalties; and
• the ability to bring actions against all responsible parties (often the action can only be brought against the employer who offers the plan, rather than the health insurer that administers it).

The details:

• The audit also found EBSA did not use many of the enforcement tools within its authority to ensure plans’ compliance because it lacked processes or faced other limitations.
• It also took up to three years for EBSA to complete NQTL comparative analysis reviews due to lack of statutory timeline requirements and inadequate staff and resources.

Our analysis: This audit offers a scathing review of parity enforcement. It confirms that the largest regulator of parity:

• does not have a tool strong enough to compel plans into compliance (civil monetary penalties);
• cannot bring actions against health plans to deter violations across different employer-sponsored plans; and
• lacks adequate staff and resources to conduct timely reviews of parity compliance.

With EBSA unable to adequately enforce parity, violations will continue, and plans will not be incentivized to comply with the law. Congress needs to provide authority to EBSA to impose civil monetary penalties, and more EBSA funding and staff are unlikely in this current political environment.

This creates incredible harm to patients who will continue to be unable to access affordable care.

Source: EBSA Faced Challenges Enforcing Compliance with Mental Health Parity Laws and Requirements (U.S. Department of Labor Office of Inspector General)