Due to recent litigation and regulatory concerns over the exclusion and limitation of treatments for autism spectrum disorder, plan sponsors of self-insured plans should review their current plan documents to determine whether any coverage limitations for ABA therapy or similar treatments will impact compliance under applicable federal and state law. We recommend this review be conducted in consultation with the plan sponsor\u2019s qualified legal counsel.<\/p>\n
Background<\/strong><\/p>\n Under the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), plans are prohibited from imposing more restrictive treatment limitations and financial requirements on mental health or substance use disorder (MH\/SUD) benefits than those that apply to medical\/surgical benefits. Additional requirements under the Consolidated Appropriations Act of 2021 required health plans and insurers that impose such limitations, known as \u201cnonquantitative treatment limitations (NQTL),\u201d on MH\/SUD benefits to conduct and perform a comparative analysis of the design and application of NQTLs to determine whether they comply with the MHPAEA requirements.<\/p>\n Recently, a Federal district court in the Ninth Circuit held that a plan\u2019s exclusion of ABA therapy and Intensive Behavioral Therapies (IBT) for a child with autism spectrum disorder violated MHPAEA by imposing more restrictive limitations on mental health benefits than those that applied to all medical and surgical benefits. This decision follows prior court cases in which ABA therapy exclusions have been challenged. In addition to the recent litigation, the DOL has indicated autism spectrum disorder treatment limitations will be an area of focus as part of its national enforcement initiative.<\/p>\n Issues to Consider<\/strong><\/p>\n\n