Managed Care Programs

Employers are depending more and more on managed care programs to reduce the rising costs of providing health insurance as a benefit to employees. Using managed care programs is one of the strategic moves that employers can take.

A managed care carve-out plan involves one health insurance provider excluding coverage for specific situations or conditions while another carrier provides coverage for these excluded conditions. These types of carve-out plans are typically preferred by employers because they offer a more cost-effective way of providing health insurance for employees.

As a managed care organization, Allied Trades (ATAP) follows organizational requirements in accordance with Mental Health Parity Laws. This compliance with such laws is not only an investment for the health and welfare funds, but for the union members.

The Mental Health Parity and Addiction Equity Act was enacted in 2008 and requires insurance coverage for mental health conditions, including substance use disorders, to be no more restrictive than insurance coverage for other medical conditions. Insurers and health plans have been able to comply with the more straightforward aspects of the law that relate to cost sharing and numerical limits on treatment (like annual inpatient day limits). However, some plans have struggled to meet the more complex components of the law that govern how they design and apply managed care practices such as prior authorization, reimbursement rate setting, and network design, among many others.

In December of 2020, Congress enacted within the Consolidated Appropriations Act (CAA) new provisions that require insurers and health plans to perform comparative analyses showing that they comply with the managed care provisions of MHPAEA. Insurers and health plans must now make these analyses available to state regulators and the U.S. Department of Labor upon request beginning February 10, 2021.

ATAP must meet the below organizational requirements to compliant with Mental Health Parity laws:

  • Individuals entering various levels of care for treatment related to both mental health and substance use disorder must meet certain medical criteria to qualify for treatment. ATAP reviews certain standardized tools and/or signs and symptoms to assure that individuals are accessing appropriate treatment to meet their needs.
    • Throughout the treatment process ATAP staff continue to monitor individuals to assure individuals are making progress within treatment and that the treatment is meeting their present needs. Concurrent reviews are done on a regular basis with treatment providers/facilities to assure this is taking place.
  • Services that are covered by ATAP require an authorization or referral form. This assures that the individual receiving care is covered under the benefits along with assures providers, facilities, and independent clinicians receive payment for said services.
    • If authorization for services is not obtained at time of admission, ATAP staff will complete a retrospective review of clinical information and assure that the individual was covered under benefits. Once all documentation is received ATAP staff will then send authorization to cover services not initially authorized.
  • Programs seeking to join ATAPs network are screened in accordance with our Center of Excellence for review of Proposed Measure of Success, Programming, and Billing Practices. Providers and facilities must provide ATAP with all state licensures, copies of accreditations, and outcome data.
  • ATAP provides a national network of providers to all members and dependents covered under the plan.

Member’s Quick Contact

All fields are required. The members quick contact portal should be utilized for basic questions regarding the Allied Trades Assistance Program's services. If this is a true emergency please contact 800-258-6376