01-05-2025
Access to mental health services: Can employers get away with not proving it?
Most employers understand the importance of good mental health and they offer a comprehensive benefits package to help employees get the services they need.
Under the Consolidated Appropriations Act, the Tri-Agencies (the Department of Labor, Health and Human Services and the U.S. Treasury) have taken it one step further by mandating a formal analysis to prove employers are in compliance with the rules of the act, called the Non-Qualitative Treatment Limitations (NQTL).
This is a tough one, but it impacts nearly every employer, so bear with me.
However, providing a formal analysis is not as easy as it sounds. On top of that, employers are randomly chosen to produce this report to the Tri-Agencies — if requested.
Those last two words — if requested — are causing a lot of angst. They're also leading employers to wonder if they should even bother with the reporting. After all, not complying could save them thousands of dollars and many hours working on the report.
That sentiment is even more relevant today with a new president in the Oval Office. Many clients are asking: Is this act and its reporting a focus of President Trump? The president is laying off government workers, so will there be anybody there to ask for this proof or follow up?
The prevailing thought is: 'maybe I'll get away with it.'
The answers are unclear, but the Employee Benefits Security Administration (EBSA) recently released a report on enforcement of the act in 2023. Many believe this is a sign that the federal government is still paying attention and is demanding accountability.
The administration investigated 102 health plans in fiscal year 2023, and it cited 31 violations in both fully insured and self-insured plans for limiting coverage.
What that means for you
Some businesses are hiring a third party to create this report if they're asked to provide it to the Tri-Agencies.
Employers with fully funded health plans can ask carriers for those reports. Carriers have all the data needed to respond to the federal government.
Self-funded plans are trickier. Data can be provided but the analysis cannot be created without a third party's help.
Employers must decide if they want to take a chance that they will not be asked to produce this report. If asked, all employers have 10 days to produce the report or face hefty fines. In general, it takes a third-party administrator six to eight months to complete the analysis report.
The reporting itself isn't easy. Employers must prove three things — annual lifetime limits, financial requirements and quantitative treatment limitations, and non-quantitative treatment limitations — in six different classifications.
If they leave just one piece of required information out of the report, their reporting will be insufficient.
In addition, many of the requirements are subjective. It would be hard for any employer to decipher what the government is looking for without professional help.
The Oswald team can help you find the right solution to create your analysis report. None of this is easy, so there is no need to tackle it alone.
Contact me at jsadlier@ or 614-696-5615.
Founded in 1893, Cleveland-based and employee-owned, Oswald is among the nation's largest independent insurance brokerages. Oswald is a founding partner of Unison Risk Advisors Inc., whose mission is to secure a thriving future for independent insurance and risk management firms; their owners, employees and clients; and their communities.
Jonathan Sadlier is the Central Ohio market president for Oswald Companies. He has more than 20 years of experience in the insurance industry. He specializes in the financial and technical aspects of plan strategy and the implementation of innovative, client-specific solutions.
