Pennsylvania was recently chosen to participate in a Commercial Parity Policy Academy, a federal initiative launched under the Obama administration that provides states with practical support to help them enforce parity laws. The Pennsylvania academy runs through August and will include virtual meetings, one-on-one coaching and an in-person forum for stakeholders.
“We have a state coach, which is an independent expert SAMHSA assigned to provide technical assistance, and we are part of a learning network with other states participating in the academies,” says Johanna Fabian-Marks, special deputy of the Bureau of Life, Accident and Health Insurance in the Pennsylvania Insurance Department.
She says several state agencies will work with stakeholders to drive implementation of parity best practices. While behavioral health treatment centers often sense that health insurers have significant improvements to make in their coverage policies, Fabian-Marks says the insurers aren’t balking at making refinements.
“Insurers have been cooperative,” she says. “It’s been a group learning experience among all parties involved in parity. We have not encounter resistance, and we look forward to working with them going forward as we establish more methods to evaluate that they are implementing parity appropriately.”
To ensure behavioral health coverage is “on par” with medical/surgical coverage, health plans must benchmark how they apply quantitative limits—such as the cost of copays for patients—as well as the more nebulous nonquantitative limits—such as prior authorization processes that could pose a logistical barrier to care. Pennsylvania has made steady progress in achieving parity for quantitative limits, however, evaluating nonquantitative limits within insurers’ medical management services continues to be a challenge, Fabian-Marks says.
According to Fabian-Marks, parity is on the radar for Gov. Tom Wolf as part of his focus on addressing the opioid epidemic. Between expanded Medicaid coverage and the marketplace exchange alone, about 175,000 individuals in Pennsylvania are receiving substance use disorder services that should be delivered according to parity law.
The insurance department is responsible for enforcing parity rules by completing insurer market conduct examinations, investigating complaints by consumers and educating consumers about their benefits. There’s still work to be done on the consumer-facing effort, Fabian-Marks says.
“The public is largely unaware of parity, and we want to figure what we can do to make people more aware of what their rights are and that they can come to the state if they believe there is a violation,” she says.
Federal officials have been on task to guide broader parity improvements for more than a year. Under President Obama, a federal Mental Health and Substance Use Disorder Parity Task Force issued a report in March 2016, which included a recommendation that SAMHSA help states by hosting public-program and commercial Parity Policy Academies this year.