Mental Health/Substance Use Disorder Parity Program

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Mental Health Substance Use Disorder (MH/SUD) Parity Program and ParityManager™ Compliance Software Solution

The Mental Health Parity and Addiction Equity Act (MHPAEA) requires employers, insurers, and certain Medicaid plans who offer mental health and substance use disorder (MH/SUD) services to offer them at parity with medical benefits. While this law has been in effect for over a decade, there continues to be variation in implementation by market and jurisdiction. 

URAC has long recognized the importance of mental health and substance use disorder treatment and the impact these services have on patients. URAC has historically included standards requiring insurers and providers to address parity and access to behavioral health services in our accreditation programs where appropriate. However, this marks the first time in which we have an entire program suite dedicated to parity compliance. Given the differing levels of oversight and complex nature of the laws governing parity, we believe a national standard for organizational capacity to comply with parity is a critical solution to improve compliance and ultimately improve the care patients receive and public health.

URAC’s MH/SUD Parity Accreditation Program is comprised of three components:

  • ParityManager™ is an enterprise software solution designed to help health plans and other organizations build, implement and manage an effective parity compliance program. Can be used by applicants during their application process, or as a stand-alone tool.
  • The MH/SUD Parity Compliance Guide is a comprehensive compliance tool that summarizes key regulations under MHPAEA. The Guide aggregates the key federal regulatory and sub-regulatory guidance into topic areas and provides practical insights and guidance on how to ensure compliance.
  • The MH/SUD Parity Accreditation Program allows organizations to show their commitment to developing and maintaining their parity compliance programs.

URAC’s compliance guide, software tool and accreditation serve as a roadmap for improved compliance with federal parity regulations and provide independent third-party validation of parity compliance program practices and performance.

 

 

 

 

ParityManager™

Applicants will use URAC’s interactive ParityManager™ software solutions to complete their MH/SUD Parity Accreditation Program applications. In addition, the secure platform can be used by health plans, third-party administrators and others to help build and maintain their respective Parity Compliance Programs even if they are not pursuing accreditation. Finally, regulators may opt to license the tool to support data collection for market conduct exams.  

URAC’s ParityManager™ includes the following industry-leading functions:

  • Provides an intuitive document management system to organize all the supporting operational documents necessary to demonstrate parity compliance
  • Uses a streamlined system to identify and classify covered benefits
  • Creates a framework for easy testing of financial requirements and quantitative treatment limits
  • Implements an innovative and streamlined approach to collecting and organizing the information necessary to perform comparability and stringency testing for non-quantitative treatment limits (NQTLs)
  • Provides a reporting function to produce parity compliance data for easy analysis; automatically identifies a wide range of parity violations and areas where there is a lack of information necessary to complete the parity compliance analysis
  • Generates important feedback loops and reports to ensure optimal parity compliance.

ParityManager™ facilitates the collection and maintenance of information needed to do a parity compliance analysis, but on its own does not automatically result in parity-compliant operations. 

 

 

 

Parity Regulatory Compliance Guide

URAC published the Mental Health and Substance Use Disorder (MH/SUD) Parity Regulatory Compliance Guide, which can be accessed through ParityManager™ or can be purchased separately.  The Guide helps summarize most of the key elements of MHPAEA and federal regulatory and sub-regulatory guidance. The document serves as an important resource for stakeholders, including Applicants that want to learn more about how to create and maintain a Parity Compliance Program. 

 

 

 

Mental Health Substance Use Disorder (MH/SUD) Parity Accreditation Program

URAC-accredited organizations are able to demonstrate to both internal and external stakeholders that they have taken critical steps toward complying with MH/SUD parity requirements. URAC’s MH/SUD parity accreditation standards track to the federal MHPAEA Final Rules and have direct relevance to many state mental health parity laws, which may explicitly reference MHPAEA or contain similar requirements.

This accreditation program helps achieve important milestones for a variety of stakeholder groups:

  • Promoting national consistency. The Standards help identify a national and consistent approach to demonstrate capacity to comply with the requirements of federal MHPAEA. Currently, there is significant variation in how health plans are demonstrating parity compliance and how state and federal regulators are enforcing it. 
  • Supplying a proactive roadmap for health plans. Until now, must of the discussion about MHSUD parity compliance has been retroactive actions against health plans and other entities. URAC’s MH/SUD Parity Accreditation Program provides a roadmap to help health plans and others create true parity between MH/SUD and medical/surgical benefits and maintain it proactively. 
  • Recognizing parity excellence. Employers and health insurance purchasers may require health plans and other health insurers to become URAC accredited to show their commitment to MH/SUD parity, as part of a request for proposal (RFP). 
  • Regulatory support. Regulators may look to URAC’s MH/SUD Parity Accreditation Standards as a framework to structure their compliance audits, policy review processes, and market conduct examinations.
  • Risk mitigation. An organization that has successfully been through the MHSUD parity process will have created a robust operational framework to limit regulatory fines and reduce the likelihood of parity-related litigation. 
  • Establishing dynamic thresholds. URAC will work with a variety of stakeholders to address areas of ambiguity and continue to move the bar higher as new regulatory guidance and other aspects of parity compliance are settled.

The standards development process was, by necessity, intensive, due to the complexity of the federal guidance on MHPAEA and the underlying complexity of the managed care system. The resulting MH/SUD Parity Accreditation Program represents a significant advance in promoting the identification, implementation, and auditing of parity compliance activities.

Our standards were developed with input from health plans, community advocates, and other health care experts.

Download our Mental Health/Substance Use Disorder Parity Program Standards-at-a-Glance.

Who may apply for Parity Accreditation?

Health plans, third-party administrators and other managed care organizations with comprehensive responsibility for medical/surgical, mental health, and substance use disorder treatment benefits

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