A guided walkthrough

How a plan proves its parity
is no more restrictive than.

Every health plan is required to prove its mental-health and addiction benefits are no more restrictive than its medical and surgical benefits — and to produce the documented analysis on demand. This is the whole model in five steps: the obligation, the framework, the side-by-side comparison, the report you receive, and what it changes. Follow one limitation from input to documented finding.

1 The obligation

The analysis every plan must keep — and the one nobody passes on first review.

Federal parity law requires every health plan to prove that its mental-health and substance-use benefits are no more restrictive than its medical and surgical benefits — not only in the plan document, but in operation. How long does approval take? How often are claims denied? Who makes the decision? Each of those comparisons must be documented for every non-quantitative treatment limitation, in every benefit classification, and produced for the Department of Labor on demand.[1]

The problem is that almost no one can produce it correctly. Across four consecutive DOL Reports to Congress, not a single NQTL comparative analysis was found sufficient on first review.[2] Plans hire consulting firms at an estimated $150,000 to $500,000 per engagement[3], wait months, and receive a binder that still fails. The scale is the reason.

MH / SUD heavier = more restrictive MED / SURG the benchmark No more restrictive than
When the beam tilts toward MH/SUD, the plan is out of parity. Equipoise measures the tilt — limitation by limitation — instead of asserting balance on paper.
2 Six elements

You bring your plan's data. Equipoise runs the federal framework.

Think of it as TurboTax for parity compliance. You enter your plan's own operational data — prior-authorization rules, denial rates, network standards, clinical criteria. Equipoise structures every analysis around the six elements the Consolidated Appropriations Act of 2021 requires[4], so all six are prompted for and each maps to a specific regulatory citation. Pick one of 9 NQTL categories across 6 benefit classifications — up to 54 comparison points per plan[1] — and the engine loads the comparison factors specific to that limitation.

ELEMENT 01

NQTL & plan terms

The limitation, the plan language that defines it, and the benefits affected.

ELEMENT 02

Factors

The variables used to decide how and when the limitation applies.

ELEMENT 03

Evidentiary standards

The evidence and sources supporting each factor.

ELEMENT 04

Comparative analysis

MH/SUD against medical/surgical, as written and in operation.

ELEMENT 05

Findings & conclusions

Whether the limitation complies, with the reasoning shown.

ELEMENT 06

Remediation plan

Corrective actions when the analysis finds non-compliance.

Equipoise does not pull your data from a payer system — you enter it, the way TurboTax doesn't pull your W-2 from payroll. The analysis, the cross-referencing, the gap identification, and the documentation: that is what the software does.

3 The comparison

Two arms, side by side, factor by factor.

The engine sets the MH/SUD arm against the medical/surgical arm and evaluates each factor for the same limitation — both as written and in operation. Where MH/SUD is more stringent in the plan language or in the outcome data, it is flagged, and the finding cites the provision that governs it. The example below is a specimen: prior authorization, inpatient, commercial.

MH / SUD
Mental health & substance use
The arm being tested
MED / SURG
Medical & surgical
The benchmark
Factor
MH / SUD
Med / Surg
Result
PA required
Yes — all stays
Select only
FAIL
Turnaround time
72 hrs
48 hrs
REVIEW
Denial rate
18.2%
6.1%
FAIL
Clinical criteria
MCG + internal
MCG
PASS
Appeal process
2-level + ext.
2-level + ext.
PASS
Fail — MH/SUD more restrictive Review — disparity to examine Pass — at parity

Specimen values, shown for illustration. In the live tool every cell links to the data you entered and the regulation that governs it.

4 The report

What you receive: a documented, citation-backed analysis.

Each finding carries the specific disparity, the regulatory citation, and a recommended corrective action with owners, deadlines, and status. Equipoise assembles them into a documentation-ready report formatted for DOL standards, with a fiduciary attestation step. The deliverable is the compliance artifact itself — the thing a plan has to produce on demand.

Equipoise · Cadence, LLC
NQTL Comparative Analysis
Prior Authorization · Inpatient In-Network · Commercial · Specimen
Findings Summary
PA scope more restrictive for MH/SUDFAIL
29 CFR 2590.712(c)(4)(iii)(A)
Denial-rate disparity (18.2% vs 6.1%)FAIL
CAA 2021 §203(a)(8)(B)
Turnaround differential (72 hrs vs 48 hrs)REVIEW
29 CFR 2590.712(c)(4)(ii)
2 Failures 1 Warning 2 Passing
Compliance assessment for decision support. Not legal advice. Equipoise automates the comparative analysis; it does not replace ERISA counsel for binding compliance determinations. Specimen for illustration.
Generated by Equipoise — NQTL Comparative Analysis
No more restrictive than — measured.

Every finding is documented, every disparity cited, and the whole analysis is exportable for ERISA-counsel review before submission. Equipoise stores no protected health information — inputs are aggregate plan-level operational metrics.

5 The outcome

You can show parity, not just hope for it.

When the examiner asks for your analysis, you hand them a methodology built on the same six-element framework they use to evaluate it — for a fraction of one consulting engagement, in minutes per NQTL rather than months. And the obligation has not gone anywhere: although the tri-Departments said in May 2025 they will not enforce or defend the 2024 Final Rule, the underlying statutory requirement under parity law and the 2013 rule remains fully in effect, private suits and DOL audits run on it, and states are enforcing independently — Georgia alone imposed more than $25 million in parity fines in 2025.[5]

Built by someone who knows this world.

Equipoise is built by Joe Nalley, who ran a 13-location integrated health system — including behavioral health and SUD/MAT — as CEO through acquisition, founded and sold ClearBill, which returned $9.2 million to payers in its first six months of full deployment, and is today Staff Vice President of Carelon Growth (Elevance Health), owning six high-acuity clinical risk books across $50B+ in specialty medical spend.[6] The engine implements the DOL's six-element framework as defined in 29 CFR 2590.712(c)(4), with the citations checked against the regulatory text and the Reports to Congress, and re-checked as guidance changes.

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Sources

  1. Core parity standard and the "no more restrictive than" requirement; 9 NQTL categories across 6 benefit classifications yields up to 54 comparison points — MHPAEA implementing regulation, 29 CFR 2590.712(c)(2)(ii) and (c)(4). ecfr.gov
  2. Not one NQTL comparative analysis was found sufficient on initial DOL review across four consecutive Reports to Congress (2022–2025) — U.S. Department of Labor, EBSA, MHPAEA Reports to Congress. dol.gov
  3. Estimated $150,000–$500,000 per NQTL consulting engagement — industry estimate based on engagement ranges from Milliman, Mercer, ATTAC Consulting, and boutique MHPAEA compliance firms.
  4. Six required elements of the written NQTL comparative analysis — Consolidated Appropriations Act, 2021, §203 (amending MHPAEA). congress.gov
  5. The 2024 Final Rule will not be enforced or defended (tri-Department statement, May 2025); statutory and 2013-rule obligations remain in effect; Georgia imposed $25M+ in parity fines in 2025 — Georgia Office of Commissioner of Insurance enforcement actions, 2025.
  6. ClearBill returned $9.2M to payers in its first six months of full deployment; founder is Staff Vice President of Carelon Growth (Elevance Health) — founder record (Joe Nalley).