28 Tex. Admin. Code § 21.2431 - Required Analyses for Quantitative and Nonquantitative Parity; Alternative Tools
(a) QTL and NQTL
templates.
(1) For purposes of this division,
"QTL template" is the template titled "Compliance Analysis for Quantitative
Parity" and its associated technical instructions, available on TDI's
website.
(2) For purposes of this
division, "NQTL template" is the template titled Compliance Analysis for
Nonquantitative Parity" and its associated technical instructions, available on
TDI's website.
(b)
Analyses of quantitative and nonquantitative parity.
(1) An issuer must analyze each health
benefit plan to determine whether its plan design complies with the
quantitative parity requirements in §§
21.2433-
21.2437 of this title (relating to
Compliance Analysis for Quantitative Parity: General Requirements, Quantitative
Parity Analysis: Issuer and Plan Information, Quantitative Parity Analysis:
Methodology for Determining Expected Payments, Quantitative Parity Analysis:
Covered Benefits, and Quantitative Parity Analysis: "Substantially All" and
"Predominant" Tests), using the QTL template, except as permitted by subsection
(c) of this section.
(2) An issuer
must analyze each health benefit plan to determine whether its plan design
complies with the nonquantitative parity requirements in §§
21.2438-
21.2441 of this title (relating to
Compliance Analysis for Nonquantitative Parity: General Instructions,
Nonquantitative Treatment Limitations Generally, Nonquantitative Parity
Analysis: Issuer and Plan Information, and Four-Step Analysis of
Nonquantitative Treatment Limitations), using the NQTL template, except as
permitted by subsection (d) of this section.
(c) Alternative tool for quantitative parity
analysis. An issuer may use an alternative quantitative parity analysis tool
instead of the QTL template if the issuer demonstrates to TDI's satisfaction
that it is using a methodology for the "predominant" and "substantially all"
tests that is consistent with §
21.2408 of this title (relating to
Parity Requirements with Respect to Financial Requirements and Treatment
Limitations).
(1) Upon request by TDI, an
issuer must produce documentation that provides the same level of specificity
as the QTL template.
(2) TDI will
assess whether the alternative compliance tool satisfies the requirements of
this section at the time TDI requests that the issuer submit its compliance
analysis.
(d) Alternative
tool for nonquantitative parity analysis. An issuer may use an alternative tool
instead of the NQTL template if the issuer demonstrates to TDI's satisfaction
that the alternative tool contains the information required for each step of
the four-step process stated in §
21.2441 of this title.
(1) Upon request by TDI, an issuer must
produce documentation that provides the same level of specificity as the NQTL
template.
(2) TDI will assess
whether the alternative tool satisfies the requirements of this section at the
time TDI requests that the issuer submit its compliance analysis.
Notes
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