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Evaluating State Mental Health and Addiction Parity Statutes: A Technical Report 25 7. Does a state statute specify that non-quantitative treatment limitations (NQTL), including but not limited to utilization review and prior authorization, must be comparable to and applied no more stringently than other medical care? (10 points available; only one answer may be selected) a. The statute explicitly uses the umbrella term NQTL in defining treatment limitation or otherwise and requires that NQTL are no more restrictive than those for physical/other medical benefits OR the statute refers to the MHPAEA (42 USC 300gg-5; 300gg-26; 29 USC 1185a) and/or the regulations (45 CFR 146.136; 29 CFR 2590.712) and requires health plans to comply* (10 points) b. The statute does not explicitly use the umbrella term NQTL in defining treatment limitation or otherwise but requires that specified NQTLs are no more restrictive than those for physical/other medical benefits (8 points) c. The statute does not explicitly use the umbrella term NQTL in defining treatment limitation, but generally requires that any treatment limitations must be comparable to those imposed on physical or other medical benefits (5 points) d. The statute is silent as to NQTL or other treatment limitations (3 points) e. The statute allows for treatment limitations that are different from those for physical/ other medical benefits (0 points) This is one of the most important areas for parity given that plans continue to struggle with the non-quantitative treatment limitation requirements of the Federal Parity Law, which does not explicitly use the term "non-quantitative treatment limitation." Non-quantitative treatment limitations are methods plans employ to limit access to treatment that are not quantifiable (e.g. medical necessity reviews, prior authorization requirements, step therapy protocols). The design and application of non-quantitative treatment limitations can be opaque, which is why additional protections beyond the Federal Parity Law can require greater transparency. For coding purposes, coders referred to the "NQTL Warning Signs" document published by the U.S. Department of Labor and Department of Health and Human Services to identify NQTL provisions that are not explicitly named NQTL (available at https://www.dol.gov/sites/default/ files/ebsa/laws-and-regulations/laws/mental-health-parity/warning-signs-plan-or-policy-nqtls- that-require-additional-analysis-to-determine-mhpaea-compliance.pdf ). Much recent activity around NQTLs is occurring at the administrative agency level, but these activities were not included in this coding scheme. *States that refer to the MHPAEA (42 USC 300gg-5; 300gg-26; 29 USC 1185a) and/or the regulations (45 CFR 146.136; 29 CFR 2590.712) but includes conflicting language in the state statute that allows for different treatment limitations were scored as 0 (impacts Arizona, Delaware, North Carolina).

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