Oregon is the only state that has adopted a statute with NQTL provisions similar to the MHPAEA.6 The Oregon Insurance Division (OID) is the office with responsibility for regulating health plans. We contacted staff at the OID and arranged for an interview about their experience in regulating NQTLs -- providing them with questions in advance.
After some initial “back and forth” with health plans and a few informal enforcement actions when the Oregon parity statute was first being implemented (for example, denying an attempt by one plan to require a treatment plan after eight outpatient visits), one of the health plans “threatened to take [OID] to a hearing" on the NQTL section of their statute. An internal review of the statutory language forestalled any further enforcement actions.
The OID staff reported the following with regard to their interpretation of NQTLs:
If the application of a differential policy seems reasonable -- with regard to the number and type of services to which it applies -- they would allow it.
They would allow differences (for example, in cost sharing and UM) for psychiatrists -- as long as all specialists were treated the same by the health plan.
They also mentioned that they had begun deferring to the federal IFR and guidance (that is, deeming health plans compliant with the Oregon rules if they are in compliance with the IFR).
6. McConnell JK, GastSHN, Ridgely MS, Wallace N, Jacuzzi N, Rieckmann T, McFarland BH, McCarty D (2012). “Behavioral health insurance parity: Does Oregon’s experience presage the national experience with the Mental Health Parity and Addiction Equity Act?”American Journal of Psychiatry, 169: 31-38.