RD408 - 2021 Report: Claims - Complaints - Appeals – Mental Health & Substance Use Disorder Benefits and Network Adequacy for the Period January 1, 2020 - December 31, 2020
As required by § 38.2-3412.1 of the Code of Virginia and in accordance with the federal Mental Health Parity and Addiction Equity Act of 2008, P.L. 110-343, mental health and substance use disorder benefits provided by group and individual health insurance coverage must be in parity with medical and surgical benefits coverage. Further, § 38.2-3412.1 G of the Code of Virginia requires:
"The Bureau of Insurance (the Bureau), in consultation with health carriers providing coverage for mental health and substance use disorder benefits pursuant to this section, shall develop reporting requirements regarding denied claims, complaints, appeals, and network adequacy involving such coverage set forth in this section. By September 1 of each year, the Bureau shall (i) compile the information for the preceding year into a report that ensures the confidentiality of individuals whose information has been reported and is written in nontechnical, readily understandable language; (ii) make the report available to the public by, among such other means as the Bureau finds appropriate, posting the reports on the Bureau's website; and (iii) submit the report to the House Committee on Labor and Commerce and the Senate Committee on Commerce and Labor."
Managed Care Health Insurance Plans (“MCHIPs") licensed in Virginia currently submit annual reports on claims, complaints and appeals to the Virginia Department of Health and to the State Corporation Commission Bureau of Insurance (the “Bureau") pursuant to §§ 32.1-137.6 C and 38.2-5804 of the Code of Virginia. However, specific information related to claims, complaints and appeals for mental health and substance use services could not be gleaned from the reports. Therefore, a separate survey was developed by the Bureau in conjunction with the Virginia Association of Health Plans (“VAHP"), and with health carriers that provide the majority of fully-insured health insurance in Virginia that are not members of VAHP, along with major input from the Virginia Department of Behavioral Health and Developmental Services. Through this survey, the Bureau receives information to help it analyze whether claims, complaints and appeals related to mental health and substance use disorder benefits are being treated in parity with claims, complaints and appeals related to medical/surgical benefits.
The report’s finding on parity within network adequacy is included as an addendum separate from the general reporting of parity comparisons of mental health and substance use abuse benefits to medical and surgical benefits.
The results of the 2021 survey, which contains information related to calendar year 2020, are provided in this report. Overall, the survey results suggest that health insurance carriers generally treat claims, complaints and appeals related to mental health and substance use disorder benefits in parity with claims, complaints and appeals related to medical/surgical benefits.
The Bureau has provided initial results from its Network Adequacy parity analysis and will continue to monitor these results to identify any areas of concern.