RD318 - Oversight of Mental Health Parity in Virginia – December 1, 2020

Executive Summary:

Senate Bill 280 of the 2020 General Assembly Session directed JLARC staff to review mental health parity in Virginia. Mental health parity refers to whether insurance companies provide mental health and substance use disorder benefits in a manner that is more restrictive than medical benefits, and guidelines and criteria that are comparable to, and no more stringent than medical guidelines and criteria. JLARC was specifically directed to review the annual mental health parity reports compiled by the Bureau of Insurance (BOI) and to assess whether improvements to BOI’s data collection are necessary to improve parity oversight and compliance in Virginia.

To conduct this review, JLARC staff interviewed Bureau of Insurance staff who review insurance plans for compliance before they are sold and staff who conduct “market conduct reviews" (sidebar) to oversee insurance plan operations. Interviews were also conducted with Virginia Department of Health (VDH) staff to understand their role in overseeing insurance plans that are sold in Virginia. To understand how other state and federal regulators oversee mental health parity, JLARC staff interviewed staff from five other states and reviewed documents from other states and the two federal agencies that oversee parity. To identify any existing indicators of potential parity violations, JLARC staff analyzed data collected by BOI from insurance plans each year. The data was analyzed to identify outliers in the denial rates, complaint rates, and appeal rates across each insurance plan. Finally, JLARC staff interviewed consumer advocacy groups, behavioral health provider associations, and three of the largest insurance carriers in Virginia about their perspectives on mental health parity.