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Evaluating State Mental Health and Addiction Parity Statutes: A Technical Report 12 The Importance of Regulatory, Compliance, and Enforcement Efforts B eyond enacting state statutes, state insurance personnel and other state regulators, including state attorneys general in some jurisdictions, are responsible for enforcing health insurance laws. To help guarantee that the Federal Parity Law and relevant state laws are properly implemented, state regulatory agencies can issue more detailed guidance including regulations, bulletins, opinion letters and frequently asked questions to clarify areas of the law. These departments can also use these documents to provide information to help enrollees, family members, and advocates understand their rights. As a result, these departments are accountable for ensuring that plans sold in the state are compliant with all relevant laws and for investigating any potential violations through detailed and thorough market conduct examinations. Additionally, state attorneys general typically have the authority to enforce state parity law, and they can investigate potentially fraudulent and illegal conduct related to consumer products, including health insurance plans. If violations of parity laws are found, attorneys general can use their enforcement powers to issue fines and compel health plans to come into compliance. Consumer parity complaints are an important facilitator of compliance and enforcement activities, yet consumers cannot be expected to submit complaints explicitly characterized as violations of parity. They do not have the information necessary to know whether limitations on their mental health or substance use disorder coverage are more restrictive than for physical health coverage. Consumers often lodge complaints and appeals with health insurers and regulators when they receive coverage denials or less reimbursement than expected. Despite this challenge, by carefully analyzing all mental health and substance use disorder complaints and appeals, regulators can identify potential parity violations. Among other options, consumers should register their complaints of denials of care at www.parityregistry.org and leverage the state-by-state resource page to obtain helpful information on filing complaints. Enforcement best practices include prospective compliance verifications and retrospective review following a consumer complaint. These best practices require plans to submit detailed parity compliance analyses and verify that these submissions in fact demonstrate compliance. It is particularly vital for the analyses and verification to occur prior to plans being offered to consumers in order to prevent parity violations and ensure consumers receive the equitable coverage to which they are entitled. Retrospective parity reviews of plans' actual MH/SUD coverage practices are also critical to effective parity enforcement to identify emerging noncompliance activities before they become a mainstream practice.

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