Nonquantitative treatment limitations (NQTLs) continue to be a source of difficulty for many health plans in attaining compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Now that a few years have passed since the implementation of the final rules, we can see examples of MHPAEA enforcement related to NQTLs and the types of NQTLs being investigated and settled. In this paper, Milliman consultants provide perspective.
Providers should understand the health insurance risk they assume through value-based payment contracts, and how this might impact their reimbursements. Risk adjustment tools like the Milliman Advanced Risk Adjusters™ (MARA™) suite identify and isolate morbidity risk factors that are beyond a provider’s control. This may result in payments that more accurately reflect a patient population’s controllable risk. In this article, Milliman’s Colleen Norris and Stoddard Davenport demonstrate how risk adjustment can minimize the financial exposure associated with the morbidity risk that providers cannot influence.