Why is understanding NQTLs so important?

By Alan Tran, Digital Content Analyst

What are NQTL’s

NQTLs, or non-quantitative treatment limitations, are a type of limit on insurance coverage for mental health services that are not based on a numerical threshold, such as a limit on the number of visits or treatments covered. Instead, NQTLs can include a wide range of restrictions or conditions that affect access to mental health services.

Determining whether a particular restriction or condition is an NQTL can sometimes be challenging. However, the Mental Health Parity and Addiction Equity Act (MHPAEA) guides what types of limitations are considered NQTLs and must be equivalent to limitations applied to medical and surgical benefits. Additionally, the U.S. Department of Labor, which is responsible for enforcing MHPAEA, has issued guidance on NQTLs to help ensure that insurers are complying with parity requirements.

Examples of NQTLs:

1. Prior authorization requirements: Insurers may require individuals to obtain pre-approval before receiving certain mental health treatments, which can delay or prevent access to care.
2. Limitations on network providers: Insurers may limit the number or type of mental health providers that are covered under a plan, which can make it difficult for individuals to find a provider who is in-network and able to provide the care they need.
3. Medical necessity reviews: Insurers may conduct reviews to determine whether a particular mental health treatment is medically necessary, which can result in delays or denials of coverage.
4. Cost-sharing requirements: Insurers may require individuals to pay a higher percentage of the cost of mental health services compared to physical health services, which can create financial barriers to accessing care.

NQTLs can be more complex and varied. Insurance plans may use NQTLs to place limits on mental health services in ways that are not immediately apparent, which can make it more difficult for individuals to access the care they need.

By understanding NQTLs, employers can avoid…

1. Legal Compliance: Employers are required to comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) and Affordable Care Act (ACA) regulations that require equal treatment of mental and physical health conditions. Failure to comply with these regulations can lead to penalties and lawsuits.
2. Avoiding Litigation: Employees who feel they have been denied access to mental health services or have been subject to discriminatory NQTLs may file lawsuits against their employers. Employers who do not understand NQTLs risk being exposed to legal action and costly settlements.
3. Employee Retention: Employees who feel that they are not being treated fairly and equitably may leave their jobs, which can result in a loss of talent and productivity for the employer. Understanding and properly implementing NQTLs can help improve employee morale and retention.
4. Positive Employer Branding: Employers who are seen as supportive of mental health care and who provide equitable access to such care can enhance their brand reputation, which can help attract top talent and improve customer loyalty.

It is crucial for employers to ensure compliance with legal requirements, avoid litigation, retain employees, and enhance their brand reputation.

If you need assistance with MHPAEA regulations and testing, CXC Solutions is here to assist with all your compliance needs.  For more information, please contact us at info@cxcnetwork.com.