What type of organizations are being audited?
The DOL is auditing insurers and employers acting as plan sponsors under ERISA including testing plans offered by self-funded groups.
What do we need to do to get ready?
Plans and employer sponsors must have extensive documentation and detailed analyses of Non-Quantitative Treatment Limitations (NQTLs) comparing their management and application of medical benefits to mental health and substance use disorder benefits. These analyses extend beyond TPAs and include pharmacy benefit administrators and other plan service providers.
How do we ensure we have adequate documentation?
Mental Health Parity documentation requirements and enforcement are tightening. ATTAC will help with the time-consuming effort of developing documentation by reviewing each NQTL comparative analysis needed across six benefit classes. We guide plans through each step of identification, evaluation and documentation of NQTLs. We also review TPA-identified NQTLs, provide feedback and identify risks; we can assist with remediation if necessary.
What do we need to include in the analysis? How can ATTAC help?
ACG will help your group prepare each NQLT analysis or review the NQTL documents your plan partners provide. The analysis must:
- Identify and define all NQTLS imposed in six benefit classifications
- Detail how plan terms apply to each benefit classification
- Identify and define all factors and evidentiary standards used to design and apply NQTLS
- Detail process of how NQTLs are applied
- Identify and define factors and processes used to monitor and evaluate the application of the NQTL
- Provide specific findings and conclusions, which includes results that indicate the plan or coverage is or is not in compliance with MHPAEA
What information does my plan need to provide to ACG? Where do we get the data?
We will partner with you to help you obtain necessary information from your TPA and/or other vendors.
How long does it take to complete the NQTL analyses?
There are many factors impacting the time needed to complete the analyses, including how long it takes to get documentation from your health plan partners and how complete the information is.
What will our analysis include?
We will provide an NQTL comparative analysis assessment and documentation including requirements which may include prior authorization procedures, network access, provider reimbursement, formulary design, and other relevant NQTLs.
What if we’re audited?
The best situation is to be prepared before the audit; ACG’s Mental Health Parity Team will help you prepared and have an audit “play book” read to go. We can also help you rapidly respond to a DOL audit request, review available NQTLs and pull together information from TPAs and others to make your best presentation to the DOL.
Why should we work with ATTAC Consulting Group?
We’re recognized as a premier national consulting, compliance, and auditing firm serving insurer and ERISA sponsors. Our experienced team performs audits and assessments to evaluate compliance with state and federal law and regulations. We have deep experience assisting clients write complete NQTL analyses and respond to the DOL expectations of a MHPAEA audit.
Don’t Go It Alone: Create a Mental Health Parity Compliance Plan Before an Audit
Compliance is complex and may cause significant risks to health plans and ERISA self-funded groups.
A Mental Health Parity and Addiction Equity Act (MHPAEA) compliance plan helps accurately detect, prevent, assess and mitigate potential noncompliance legal risks.