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.

Jump to Page

Privacy Preference Center

When you visit any website, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalized web experience. Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.

Strictly Necessary Cookies

These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms. You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.

Performance Cookies

These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. They help us to know which pages are the most and least popular and see how visitors move around the site. All information these cookies collect is aggregated and therefore anonymous. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.