An excessively high rate of denials for behavioral health services in comparison to a lower rate of denials for medical/surgical services could be a potential parity violation of the Federal Parity Law.
- This discrepancy could be remedied by decreasing the percentage of denials for mental health and substance misuse disorder claims to be more on a par with medical/surgical rates.
- This strategy could remove the appearance of a parity violation, but the potential danger lies in what’s under the quantitative surface of percentages on a par.
- It is the ways in which the medical necessity criteria (MNC) are applied to individual cases that are critical in determining whether approvals or denials for treatment are appropriate on either side of the divide.
- For true parity to be determined, a deeper dive into the clinical content of adverse determination letters (“denials”) on a case-by-case basis would be required.
To obtain a solid Parity Compliance bill of health, take advantage of SAE’s Parity Team’s mixed methodological approach where they apply and combine both qualitative and quantitative strategies to assess MHPAEA compliance.
On a micro level, qualitative methodologies provide a granular case-by-case clinical analysis reviewing the reasons why a particular claim for med/surg or behavioral health services were approved or denied. Utilizing a robust sample of adverse determination letters, the Parity Team can quantify the qualitative findings and contrast these with the evidence provided by a quantitative macro level of statistical analyses to large data sets of claims to provide the most accurate determination of Federal Parity Compliance. This method is called “triangulation” of data, using two separate sources of data to bear on one focal point, “parity compliance” with the Federal Parity Law and its 2021 Amendment.
To ensure a solid, true compliance assessment with the 2008 Mental Health Parity and Addictions Equity Act and the 2021 Consolidated Appropriations Act that amended MHPAEA, let the Parity Experts at SAE lead the way!
SAE’s Parity Team, Brian Baldwin, LCSW, Alex Hutchinson, MBA and Maria Messina, PhD provide an intersectional view of parity and compliance with unique and complementary approaches to assessing parity, considering the impact of structural flaws in the U.S. healthcare system.
