Our clients often ask our consultants why it's critical to work with an independent third party to do a MHPAEA (Mental Health Parity and Addiction Equity Act) analysis. Simply put, having a vendor partner complete the analysis is somewhat like asking a fox to guard the henhouse. A third-party review gives an unbiased, objective perspective to provide accurate evaluations of a carrier’s adherence to regulations and standards. This independence improves credibility with stakeholders, identifying potential risks by providing a more comprehensive review of industry practices, and is often necessary for demonstrating compliance to external parties like the Department of Labor or plaintiff’s attorneys.
A few other critical points:
- Objectivity and unbiased perspective: We haven’t seen venders do non-quantitative treatment limitations (NQTL) comparative analyses on their own plans, which could identify parity issues. This is worrying because we’ve found several parity concerns when performing similar NQTL comparative analyses on each of the carriers, suggesting some inherent biases may exist when vendors do their own analysis. Given the significant audit and litigation in this area, it's important to identify issues to appropriately guard your plan.
- Risk mitigation: A large national carrier just paid over $15 million to settle litigation surrounding their concurrent review and reimbursement rates in both self-funded and fully insured plans. Given the significant problems across the structure of third party administered programs, it seems risky to rely on their independent analysis versus asking for a third-party review.
- Comprehensive review: Unless your client uses the same vendors for medical, prescription drug and employee assistance programs, there would be no consistency across the NQTLs. These should all be included in the review.
- Enhanced credibility and trust: Several members of the Department of Labor have also informally stressed many of these issues and confirmed that the use of third parties to conduct the NQTL analysis would be a helpful way to ensure true parity.
It's for these reasons that we’ve developed capabilities to perform MHPAEA Assessments on behalf of our clients. As the landscape of mental health parity continues to evolve, it's clear that independent MHPAEA reviews will play a vital role in helping organizations stay ahead of regulatory requirements. By prioritizing objective analysis and comprehensive review, you can protect your organization from potential risks and demonstrate a commitment to true parity.
