To: The Office of the Assistant Secretary for Planning and Evaluation
From: Tim Clement, Senior Policy Advisor for the Kennedy Forum
RE: Oral Comments at 7/27/27 Parity Listening Session
On behalf of Patrick Kennedy and the Kennedy Forum I would like to thank the Administration for its continued focus on parity. Parity is a bipartisan issue and one of the few topics in health care on which Republicans and Democrats can agree. My comments today will be brief because many in the room have already heard much of what I and Congressman Kennedy have said regarding what we think must occur in order to achieve true parity, which, unfortunately, is not the current reality.
First, we are very pleased with the great work produced by the Federal Departments over the course of the last 18 to 24 months. There have been some outstanding FAQs, a much needed "warning signs" document on non-quantitative treatment limitations, a disclosure guide, and the CMS parity toolkit, to name a few items. We applaud the Departments for creating these materials and encourage them to continue to lean on the top parity experts in the country as they craft additional guidance documents and templates.
We have had the great fortune of being able to work with and learn from some state regulatory agencies and we have also added a key member to our team in Michael Reisman, who was very instrumental in all of the parity-related settlements reached by the New York State Attorney General’s Office. This work with state regulators and the wealth of knowledge that Michael has provided has given us insight into the challenges that exist in implementing the Federal Parity Law and related state statutes. This has also shown us that the biggest area of continued need remains centered on nonquantitative treatment limitations, or NQTLs.
To that end, the Kennedy Forum’s recommendations are very direct and simple:
- There must be a standardized and logical format for how health plans and issuers perform comparative analyses of the design and application of NQTLs.
- There must be standardized template for regulators to use to collect these analyses in order to examine them for compliance or lack thereof.
I cannot stress enough the importance of standardization and uniformity when it comes to analyzing NQTL design and application. NQTL analyses can be very complex and all stakeholders, including health plans and issuers, state regulators, providers, and consumers, would benefit from adopting a common approach. The foundation for this approach should be grounded in examining the four key descriptive terms in the final regulations: processes, strategies, evidentiary standards, and factors. The examination must take into account that determining whether there is comparability and equivalent stringency is a two- part test comprised of both the as written component and the in operation component. Considering that analyses as such could quickly become unwieldy, we recommend that the most efficient and orderly way to proceed is to organize the analyses into a series of steps for health plans and issuers to follow.
Structuring NQTL analyses as such will simplify the task of determining compliance for regulators and provide a needed level of administrative clarity for plans and issuers. And, of course, if a standardized approach is adopted for NQTL analysis, it would only make sense that a standardized template is used to collect this information. State regulators would still have plenty of flexibility to use the template in a way that best suits the needs of their state in that they could choose to collect data on the NQTLs that they believe are most in need of examination in their state. One state may choose to focus on NQTLs related to utilization management while another might focus on NQTLs that affect network adequacy.
While there are many other issues related to parity that must be addressed, creating this common approach to NQTL analysis is by far the most important and one in need of immediate attention. Thank you for this opportunity to speak and the Kennedy Forum looks forward to continued collaboration with the Departments.
