Evaluating State Mental Health and Addiction Parity Statutes: A Technical Report
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The Attorney General's Office levied over $3 million in penalties and ordered reprocessing of
claims that resulted in payment of millions of dollars in previously-withheld reimbursement
to enrollees and providers. Nearly half of denials re-reviewed as part of settlements were
overturned on appeal.
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The health plans involved in these investigations are also monitored
to ensure parity compliance is reached and maintained.
Oregon: Regulations with Greater Specificity than Federal Rule
The Oregon Department of Consumer and Business Services issued regulations that go beyond
the specificity of the final rules of the Federal Parity Law in several ways. The regulations
prohibit insurers from excluding coverage solely because an entire course of treatment was not
completed or because the treatment was court-ordered. Additionally, the regulations disallow
insurers from categorically excluding a form of treatment for a mental health condition.
Pennsylvania: Consumer Guide
The Pennsylvania Insurance Department released a comprehensive consumer guide to behavioral
health. The report is divided into different types of insurance. It then specifies the rights
consumers are entitled to under each insurance plan. The final section provides resources for
individuals if they need further assistance. Other states have also developed these tailored tools.
Texas: Collecting and Publishing Health Insurer Data
The Texas Department of Insurance released a report in August 2018 comparing data on
how insurance plans in the state covered MH/SUD versus medical and surgical care. Required
by House Bill 10, passed in 2017, the report examined data relating to prior authorization
utilization, claims denials, appeals, and external reviews. The Texas Health and Human Services
Commission released a similar report on Medicaid managed care organization data. While such
public data reporting should occur on a regular basis, these one-time Texas reports increased
transparency on metrics that are related to parity and can give insights on where the greatest
problems are in MH/SUD coverage.
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Ollove, M. (2015, May 7). Despite Laws, Mental Health Still Getting Short Shrift. Pew, Stateline. Retrieved from https://www.
pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/5/07/despite-laws-mental-health-still-getting-short-shrift.
