Listen to our SAE CAREs Podcasts below on the Parity Law and the challenges in complying with it, part of our Parity Series!
SAE & Associates has experience assessing, monitoring, and developing process changes to assist with the implementation and enforcement of Parity compliance for different entities, health products, and market participants. We identify covered services by classifications and use data to critically map policy and practice changes for processes, strategies and evidentiary requirements related to:
- Quantitative Treatment Limits (QTLs)
- Non-Quantitative Treatment Limits (NQTLs)
- Financial Requirements (FRs)
- Aggregate Lifetime and annual dollar limits (ALs) and (ADLs)
- Availability of information to enrollees or beneficiaries.
Our Independent Compliance Administrator (ICA) Parity team has experienced and knowledgeable health administrators and clinical experts with the proven ability to:
- identify the state of Parity implementation and required stages of change to meet compliance requirements;
- conduct clinical reviews of treatment necessity and interpret clinical determinations for medical necessity across classifications of covered services and product design;
- review and analyze operational processes, strategies and evidentiary requirements to demonstrate compliance across practice, procedure, and policy; and
- evaluate for ongoing process measures and data for compliance and sustainability of change processes.
Grounded in clinical and policy knowledge and with direct experience in the provision of mental health and substance addiction treatment, our ICA Parity team assists with the interpretation of policy to practice, aiming to improve and verify true access to care. The team is able to dive deeply into reviews of the following:
- expected cost sharing and service design by market product,
- comparability of medical/surgical (M/S) and mental health (MH) and substance use disorder (SUD) data sets across QTLs, NQTLs, FRs and ALs/ADLs,
- product design and protocol for communication with adverse determinations,
- MH and SUD network adequacy and comparability with M/S across classifications and covered services, and
- organizational process change of structure and culture to implement compliance practice and policy changes.
Substantial data metric sets to identify and evaluate the impact of behavioral health service and system changes include but are not limited to:
- Spend and utilization changes, utilization review rates, medical necessity denial rates, internal appeal/reversal rates and external appeal/reversal rates across all levels of care to measure sustainability of change; and
- High level comparison of utilization review/denial rates and trends for behavioral health services versus those for physical health services.
SAE can help OAGs (Office of the Attorney General) by:
- Providing assistance in gathering both pertinent information and data metric solutions to evaluate the current degree of Parity compliance of a Health plan and its behavioral health vendor - a Discovery phase;
- Functioning as an external Parity compliance administrator, assessing the Health Plan's movement toward compliance as defined by terms of a settlement; and
- Functioning as an external reviewer of a Health Plan's internal Parity compliance efforts either voluntarily initiated by the Health Plan or mandated by a settlement derived from litigation.
SAE can help Insurance Commissioners by:
- Guiding them in forming the standards and requirements that Health Plans must demonstrate compliance with;
- Collecting data and analyzing health plan policy and practice, as they relate to the requirements of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA);
- Utilizing a sophisticated data metrics approach to measure compliance against both Quantitative Treatment Limitation (QTL) and Non-Quantitative Treatment Limitation (NQTL) Parity requirements; and
- Determining the information and data needed to begin an overview of a Health Plan's structure and design.
SAE can help Health Plans by:
- Providing external Parity compliance monitoring of their efforts to meet Parity;
- Helping Health Plans organize their data; and
- Refining their approach and putting a robust structure in place to ensure that Parity compliance is not only met, but also sustained.
View the bios of our key Parity Compliance Consultants:
- Steven A. Estrine, PhD
- Frank McCorry, PhD
- Loan Mai, PhD
- Alex Hutchinson, MBA
- Brian Baldwin, LCSW
- Maria Messina, PhD
SAE White Paper - Parity: The Issues, Challenges and Opportunities
SAE Webinar Presentation - Mental Health Parity And Addiction Equity Act (MHPAEA): Measuring And Ensuring Compliance
Additional Parity Resources: