The Departments of Labor, Health and Human Services, and the Treasury, along with state departments of insurance, have ramped up enforcement of insurers’ parity compliance operations and documentation, particularly for insurers that use vendors to administer their behavioral health benefits and build their behavioral health provider networks (“carve-out vendors”). Drafting parity-compliant documentation incorporating separate and often disparate insurer and carve-out vendor operations presents unique challenges and is often the root cause of a regulator investigation and determination of parity noncompliance. Epstein Becker Green (EBG) has extensive experience in counseling such clients to proactively create and maintain parity-compliant operations with the use of carve-out vendors and in addressing mental health parity deficiencies common in insurers that use carve-out vendors.
For example, EBG provides strategic advice and counsel to an insurer that uses a behavioral health carve-out vendor. This insurer entered into an agreement with a state regulator wherein the insurer and its carve-out vendor had to modify their operations and improve their parity compliance documentation in order to achieve parity compliance. EBG assisted the insurer in creating a global mental health parity compliance governance program that achieved the requirements of the regulator agreement and that was tailored to the complex nuances of an insurer using a behavioral health carve-out vendor. EBG also assisted both the insurer and carve-out vendor in drafting joint non-quantitative treatment limitation documentation that thoughtfully compared the insurer’s and carve-out vendor’s operations and outcomes data. Such assistance involved EBG coordinating and leading working-session meetings with the insurer’s and carve-out vendor’s relevant operations teams, ensuring that both organizations’ operations were aligned in a parity-compliant manner, and assisting in creating universal data-pull templates for parity operations metrics requirements.
Our attorneys provide strategic advice and counsel for insurers’ parity programs and oversee all necessary steps in drafting and defending parity documentation co-authored by insurers and their behavioral health carve-out vendors. We are pleased to help insurers achieve parity compliance under the complex and challenging circumstances inherent in using a carve-out vendor.
Results may vary depending on your particular facts and legal circumstances.
