PARITY LAW COMPLIANCE

​The resources below relate to parity law compliance, including non-quantitative treatment limitations ("NQTLs"):

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• 2024 Model Data Request Form (MDRF) - All 5 Sections (Updated) – Quantitative data templates used by employers, employer coalitions, regulators and other stakeholders in requesting targeted, quantitative data from third party administrators and insurers for assessment of access to in-network behavioral health services. The MDRF has been used as a source and template by multiple regulators. Note: Clicking the link above or the links below will download a Word document to your computer, which contains embedded Excel files.

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• MDRF Section 1 Only - Out-of-Network Use

• MDRF Section 2 Only - Reimbursement

• MDRF Section 3 Only - Provider Participation

• MDRF Section 4 Only - Denial Rates

• MDRF Section 5 Only - UR Frequency/Proportion

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• 2024 Nonquantitative Treatment Limitation (NQTL) Multi-Step Comparative Analysis Audit Tools – These Tools, developed by Henry Harbin, MD and Beth Ann Middlebrook, JD, set forth instructions and requirements for use by regulators, employers/healthcare purchasers and carriers/TPAs/service providers to perform and appropriately document comparative analyses of NQTLs developed and applied to mental health/substance use disorder (MH/SU) benefits compared to medical/surgical (M/S) benefits. There are two separate NQTL Multi-Step Audit Tools covering 5 NQTLs:

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• NQTL Multi-Step Audit Tool for: Utilization Management (UM) protocols of (1) Prior Authorization, (2) Concurrent Review and (3) Retrospective Review (pre-claim payment and post-claim payment); and

• NQTL Multi-Step Audit Tool for: (4) Network Composition/Adequacy and (5) In-Network Reimbursements     

 

• The audit tools also contain embedded Model Data Request Form (MDRF) quantitative outcomes data templates containing definitions, instructions and tables by which to perform “in operation” comparative data analyses. Note: Clicking the link above will download a Word document to your computer.

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PRIOR KEY DOCUMENTS, ANALYSES AND ISSUE BRIEFS

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• BFF Comments on Federal Parity Law (MHPAEA) Proposed Rule 2023

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• BFF Comments on MHPAEA Technical Release 2023 – Note that the MDRF is referenced in Appendix A of the Technical Release

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• 2023 ISSUE BRIEF: Federal Parity Law (MHPAEA): NQTL of In-Network Reimbursement Rates: Non-Comparable Use of Factors of Provider Leverage a/k/a Bargaining Power and Workforce Shortages – An issue brief analyzing how some health insurance plans / carriers define and use the factors of provider leverage and workforce shortages non-comparably and more stringently to support lower in-network reimbursement rates for MH/SU providers as compared to M/S providers

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• 2022 Model Hold Harmless Language – Sample indemnification/hold harmless clause for use by employers in their vendor contracts with third party administrators, related to parity law compliance

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• 2022 ISSUE BRIEF: Behavioral Health Crisis Services Governed by the No Surprises Act and the Federal Parity Law​

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• 2022 American Psychiatric Association Letter to DOL Documenting Gaps in Parity Enforcement

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• 2021 UPDATED ISSUE BRIEF: State Regulators' Use of Required Quantitative Data Templates to Assess NQTL Parity Compliance – An issue brief identifying a number of quantitative templates (MDRF as source) that several state regulators are requiring as they assess NQTL parity compliance

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• 2018-2021 Excerpts from Issue Briefs on Parity Compliance and Behavioral Health Network Adequacy Published by National Alliance of Healthcare Purchaser Coalitions

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• 2017 Six-Steps Parity Guide for NQTL Compliance – A detailed issue brief covering specific types of non-quantitative treatment limitations governed by the federal parity law and regulations, with detailed illustrations to assist issuers, regulators or others​​​​​​​