Non-Quantitative Treatment
Limitation Analyses and Compliance Under MHPAEA (CMS-10773)
Revision of a currently approved collection
No
Regular
09/26/2024
Requested
Previously Approved
36 Months From Approved
03/31/2025
252,445
36,461
2,902,353
1,013,185
0
0
The Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)
(P.L.110-343) generally requires that group health plans and group
health insurance issuers offering mental health or substance use
disorder (MH/SUD) benefits in addition to medical and surgical
(med/surg) benefits do not apply any more restrictive financial
requirements (e.g., co-pays, deductibles) and/or treatment
limitations (e.g., visit limits, prior authorizations) to MH/SUD
benefits than those requirements and/or limitations applied to
substantially all med/surg benefits. The Patient Protection and
Affordable Care Act, Pub. L. 111-148, was enacted on March 23,
2010, and the Health Care and Education Reconciliation Act of 2010,
Pub. L. 111-152, was enacted on March 30, 2010. These statutes are
collectively known as the “Affordable Care Act.” The Affordable
Care Act extended MHPAEA to apply to the individual health
insurance market. The Consolidated Appropriations Act of 2021 (the
Appropriations Act) was enacted on December 27, 2020. The
Appropriations Act amended MHPAEA, in part, by expressly requiring
group health plans and health insurance issuers offering group or
individual health insurance coverage that offer both
medical/surgical benefits and MH/SUD benefits and that impose
non-quantitative treatment limitations (NQTLs) on MH/SUD benefits
to perform and document their comparative analyses of the design
and application of NQTLs. Further, beginning 45 days after the date
of enactment of the Appropriations Act, group health plans and
health insurance issuers offering group or individual health
insurance coverage must make their comparative analyses available
to the Departments of Labor, Health and Human Services (HHS), and
the Treasury or applicable state authorities, upon request. The
Appropriations Act also requires the Secretary of HHS to submit to
Congress, and make publicly available, an annual report on the
conclusions of the reviews.
Due to a decrease in the
estimated number of issuers, the estimated burden related to the
NQTL comparative analyses documentation and recordkeeping for
issuers has decreased by 2,827 hours (from 82,827 to 80,000).
Similarly, due to a decrease in the estimated number of
self-funded, non-Federal governmental plans, the estimated burden
related to the NQTL comparative analyses documentation and
recordkeeping for self-funded, non-Federal governmental plans has
decreased by approximately 48,080 hours (from 930,107 to 882,027).
However, there is a new burden for issuers and self-funded,
non-Federal governmental plans associated with the proposed
documentation and data requirements for NQTL comparative analyses,
of 160,000 hours and approximately 1,764,053 hours, respectively.
The estimated burden to issuers and self-funded, non-Federal
governmental plans associated with the initial submission of
comparative analyses has increased by 100 hours (from 0 to 100).
The estimated burden to issuers and self-funded, non-Federal
governmental plans associated with the submission of additional
documentation for comparative analyses has increased by 50 hours
(from 50 to 100), due to an increase in the number of plans and
issuers that are expected to submit additional documentation.
Further, due to an increase in the estimated number of issuers and
self-funded, non-Federal governmental plans needing to complete
corrective actions to bring their NQTLs into compliance, the
estimated burden related to corrective actions has increased by 600
hours (from 200 to 800). Additionally, there is a new burden to
issuers and non-Federal governmental plans associated with consumer
requests for comparative analyses (of approximately 7,636 hours).
Lastly, there is a new burden to issuers and non-Federal
governmental plans associated with the recordkeeping requirement in
the 2023 proposed rules (of approximately 7,636 hours). Therefore,
total burden hours have increased by approximately 1,889,167 hours
(from 1,013,185 to 2,902,352).
$2,000,000
No
No
No
Yes
No
No
No
Jamaa Hill 301 492-4190
No
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
CMS-10773 - Track Change.docx
Consumer Requests for Comparative Analyses