• Employer Home
• Document Center
• HIPAA
• Renewal Certification
• FAQs
• Mental Health Parity and Addiction Equity Act (MHPAEA)
• Update Web Account
• Forms
• Contact Us
• FAQs

MHP Overview:

The Mental Health Parity and Addiction Equity Act (MHPAEA) requires that treatment limitations and financial requirements for mental health and substance use disorder benefits cannot be more restrictive than those for medical/surgical benefits. BCBSRI members and group accounts have the right to request and receive our documented analyses of these plan and benefit limitations, known as Non-Quantitative Treatment Limitations (NQTLs) and Quantitative Treatment Limitations (QTLs).

· NQTL: limitations that affect the scope or duration of benefits under the plan that are not expressed numerically. Some examples include prior authorization requirements or network adequacy.

· QTL: numerical limitations on benefits, such as cost sharing.

Effective for plan years beginning on or after January 1, 2025, the MHPAEA Final Rule, which was issued on September 9, 2024, imposes a requirement that named fiduciaries of Employee Retirement Income Security Act of 1974 ('ERISA') plans provide a certification related to the NQTL comparative analysis requirements. According to MHPAEA, a named fiduciary must: (1) select and monitor a qualified service provider to perform the NQTL comparative analysis, (2) review and ask questions about the analysis, and (3) ask that the service provider provide assurances that, to the best of its ability, the comparative analysis complies with ERISA. The named fiduciary should further ensure that a certification is then included in, or with, the comparative analysis. In support of your efforts to meet the requirements, you may find our standard NQTL analyses prepared with reference to our fully insured plans.

NQTLs:

• Standard for Providing Access to Out of Network Providers (Revision Date: 02/27/2025)
• Exclusions of Specific Treatments for Specific Conditions (Revision Date: 02/27/2025)
• Restrictions on Provider Billing Codes and Restrictions Based on Geographic Location, Facility Type, Provider Specialty, and Other Criteria That Limit the Scope or Duration of Benefits (Revision Date: 02/27/2025)
• Medical Management, Prior Authorization, and Concurrent Review (Revision Date: 02/27/2025)
• Medical Management NQTL (Medical management standards limiting or excluding benefits based on medical necessity or medical appropriateness, or based on whether the treatment is experimental or investigative) (Revision Date: 03/13/2025)
• Network Adequacy (Revision Date: 03/24/2025)
• Credentialing Standards for Participation in its Network - Health Delivery Organizations & Professional Providers (Revision Date: 03/19/2025)
• Network Tier Design (Revision Date: 02/27/2025)
• Reimbursement Rates (Revision Date: 03/24/2025)
• Step therapy/fail first (non-pharmacy) (Revision Date: 03/13/2025)

Note:

BCBSRI has prepared these NQTL analyses in accordance with MHPAEA to the best of its ability. As the law in this area continues to evolve, BCBSRI cannot certify that the analyses will meet all requirements. These documents may be updated from time to time. In providing these analyses, BCBSRI is not serving as a legal adviser to the plan sponsor or plan administrator. Please consult your legal counsel if you determine it is necessary.

It is important to note that the information in these NQTL analyses is based on federal guidance under MHPAEA and Blue Cross & Blue Shield of Rhode Island’s (BCBSRI) fully insured standard plan design and operations, and does not include non-standard plan benefits, exclusions, or processes specific to your group health plan(s). Any benefits administered or insured by another entity are not included in this analysis. As a plan sponsor for your group health plan(s), you remain responsible for performing and documenting the comparative analyses specific to your plan(s) and providing them in response to requests by a regulatory agency, member, or any other person or entity. If you require additional information, please reach out to your account manager.

The NQTL documents contain confidential, trade secret, and proprietary BCBSRI information, and you may not use or disclose this information other than as set forth in your agreement with BCBSRI. The information provided is based on 2024 data. Additional plan information is also accessible on the BCBSRI’s employer portal, available: Employee | Blue Cross Blue Shield of Rhode Island.

Final Rule Fiduciary Certification Requirement: The most recent MHPAEA final rule, issued September of 2024, requires additional compliance steps for employer plans subject to the Employee Retirement Income Security Act of 1974 (ERISA). The rule imposes a new requirement that the NQTL comparative analysis include a “fiduciary certification.” This provision is effective for plan years beginning on or after January 1, 2025. The certification must state that the fiduciary engaged in a prudent process to select qualified service provider(s) to perform and document a comparative analysis in connection with the imposition of any NQTLs applied to MH/SUD benefits under the plan, and that the fiduciary has monitored those service providers with respect to the comparative analysis. The requirement applies to both insured and self-insured ERISA plans.

Role of Fiduciary: The named fiduciary is responsible for:

1. Reviewing the comparative analysis prepared by the plan;
2. Asking questions and require the plan to clarify any discrepancies with the comparative analysis;
3. Understanding the findings and conclusions prepared by the plan;
4. Ensuring that the service provider is in compliance with MHPAEA and has completed the comparative analysis to the best of their ability;
5. If it is determined that the comparative analysis is deficient, the fiduciary should note what the plan will do to correct the deficiencies and document the corrective actions.

Role of BCBSRI: BCBSRI’s goal is to support the final rule requirement by providing the appropriate communication and process to support employers and their named fiduciary in meeting their obligations under the final rule. While the role of BCBSRI differs for fully insured and self-funded accounts, in neither case is BCBSRI a fiduciary for purposes of the certification.

Instructions: For additional information, including Quantitative Treatment Limits (QTLs), account specific claims data (for self-funded plans only), reimbursement rates, and supporting policies & procedures please contact your account executive or call our main number at (401) 459-1000 or 1-800-637-3718 outside Rhode Island.