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PARITY LAW COMPLIANCE

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

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  • 2025 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 Word documents to your computer, which contain embedded Excel files.)
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  • 2025 Nonquantitative Treatment Limitation (NQTL) Multi-Step Comparative Analysis Audit Tools – These Tools set forth instructions and requirements for use by regulators, insurance issuers, employer group plans, and 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. You may access/download: 1. the UM Protocols Tool, 2. the Network Adequacy/INN Reimbursement Tool, or 3. the combined Tool that includes both:
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  1. 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)
  2. NQTL Multi-Step Audit Tool for: (4) Network Adequacy and (5) In-Network Reimbursements
  3. NQTL Multi-Step Audit Tools for UM Protocols and Network Adequacy/In-Network Reimbursements
 
  • The audit tools also contain embedded Model Data Request Form (MDRF) quantitative outcomes data templates with definitions, instructions and tables for conducting “in operation” comparative data analyses in a consistent and validated manner. (Note: Clicking the links above will download Word documents to your computer.)

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PRIOR KEY DOCUMENTS, ANALYSES AND ISSUE BRIEFS

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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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  • 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​​​​​​​

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