Substantial Improvements to Mental Health and Substance Use Disorder Coverage in Response to the Mental Health Parity and Addiction Equity Act of 2008. Non-Quantitative Treatment Limits


The study cites some examples in large employer-based plans for 2010 of NQTLs that were stricter for MH/SUD benefits than for medical/surgical benefits. Below are some of the more common types of NQTLs that appeared to be problematic:

  • MH/SUD precertification requirements were more stringent than those used for medical/surgical benefits.
  • Medical necessity criteria appeared to apply differently to MH/SUD services compared to medical/surgical services.
  • Retrospective reviews were routinely used for MH/SUD services but not medical/surgical services.
  • Reimbursement rates for MH/SUD services were based on lower percentages of usual, customary and reasonable standards than medical/surgical services.


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"mhsudRB_0.pdf" (pdf, 181.82Kb)

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