Section 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.28 Tex. Admin. Code § 21.2431
Adopted by Texas Register, Volume 46, Number 36, September 3, 2021, TexReg 5588, eff. 9/7/2021