Non-Quantitative Treatment Limitation
Independent Consultation & Self-Funded Health Plan Evaluation (ICE)
With plan complexity in the self-funded world intensifying in response to constantly shifting regulations and statutes, The Phia Group offers Independent Consultation & Evaluation (or “ICE”) services to any and all entities engaged in the health benefits industry. For a capitated monthly fee, users gain unlimited access to The Phia Group’s acclaimed legal consultants on all regulatory compliance issues, multifaceted factual dilemmas, business disputes, and other situations involving administration of a self-funded health plan. The Phia Group’s renowned team of consulting attorneys can assess the issues involved, conduct thorough legal research, consult on best practices, and, ultimately, provide unparalleled support.
From fact-finding to advice on claims processing and adjudication; helping with stop-loss disputes to complicated appeals; assessing Administrative Service Agreements, HIPAA Business Associate Agreements, network contracts and vendor statements of work; with ICE, The Phia Group supports plan sponsors and administrators every step of the way. Where in the past entities may have paid many thousands of dollars to a law firm, in instances where formal legal representation is not required, now they can access superior industry expertise for a fraction of the cost. Whether you need help with plan establishment, licensing, administration, conflict resolution, or revisions in response to changing laws, ICE has you covered – without limit or increase in cost.
Please contact us to schedule a self-funded health plan evaluation with our team of experts today.
Non-Quantitative Treatment Limitations
Federal law requires that Non-Quantitative Treatment Limitations (NQTLs) applied to benefits for the treatment of Mental Health and Substance Use Disorders (“MH/SUD”) be applied no more stringently than NQTLs applied to medical benefits. This is to ensure appropriate care for individuals needing MH/SUD treatment and to remove the stigma associated with MH/SUD illnesses. The Consolidated Appropriations Act of 2021 expanded the groundwork laid out by the Mental Health Parity and Addiction Equity Act (MHPAEA) by requiring health plans to perform a six-step NQTL analysis, to document compliance with the parity requirements and demonstrate whether the health plan compliantly applies its benefit limitations in parity with respect to MH/SUD benefits.
The Phia Group will not only help you perfect your health plan through plan drafting, but we can also help perform the NQTL analysis required by the Department of Labor. Contact us today for all your health plan needs.