Georgia insurance regulators have issued nearly $25 million in fines to 11 health insurers following market conduct examinations that identified violations of state parity requirements and violations of the federal Mental Health Parity and Addiction Equity Act (MHPAEA). As reported by Becker’s Payer Issues, regulators cited discrepancies in benefit design and the application of non-quantitative treatment limitations (NQTLs), resulting in unequal coverage for behavioral health treatment.
Non-quantitative treatment limitations, or NQTLs, are non-numerical limits on benefits, including prior authorization requirements, medical necessity criteria, step-therapy protocols or network admission standards that can affect access to mental health and substance use disorder services. Regulators are increasingly scrutinizing how health plans design, apply and document NQTLs to ensure parity with medical and surgical benefits.
The enforcement action reflects intensified focus on mental health parity compliance at the state level. URAC’s Mental Health and Substance Use Disorder (MHSUD) Parity Accreditation provides a structured framework for demonstrating compliance with MHPAEA and state parity laws. URAC’s ParityManager™ software supports ongoing NQTL analysis, documentation and risk monitoring to help health plans prepare for parity audits, reduce regulatory exposure and strengthen equitable access to behavioral health services.
