The Kennedy Forum Offers Resources to Support State Model Legislation
When a mental health insurance claim is submitted, there are numerous points at which people may get denied because parity is not strongly enforced – largely due to a lack of streamlined reporting, according to The Kennedy Forum Senior Director of Policy Lauren Finke.
“In most states, this is where insurers are hiding the majority of their parity violations,” Finke said.
That’s why Finke, a state parity expert, was invited to Connecticut to testify on behalf of S.B. 10, which adds “needed clarity and teeth” to make health insurance processes more transparent.
For instance, state or federal law may require that insurers rely on third-party criteria vs. in-house guidelines to determine general standards of care, a rubric for ensuring care aligned with clinical practice and opinion on medical necessity.
“Insurers may not use the clinical standards of care or say they do when they don’t, because the law is flexible and largely unenforced,” Finke said. “That’s why it was so important to have the parity final rules that reclarified that plans have to show the pathways from what you’re using to make determinations to the kind of care that people are getting.”
“States have a huge tool available to them which is to put standards in place that clarify how the criteria for generally accepted standards of care should be used. That’s where states like Georgia, New Mexico, and TKF laboratory states like California and Illinois are leading – and now Connecticut may join their ranks,” Finke said.
This is just one of several core issues that states are taking on through legislation like S.B. 10. The Kennedy Forum offers tools, resources, and expertise to states who want to follow.
How The Kennedy Forum Can Help in Your State
Finke has already been working with states in the State Parity Workgroup (request to join here) to talk about parity developments and pathways for creating greater parity enforcement.
Now, Finke and team are developing a set of gold standards for parity implementation at the state level, many of which are evident in S.B. 10, like streamlined reporting, ensuring generally accepted standards of care determined by clinical standards that tie with utilization review, and empowering regulators to work with plans when violations are found.
The gold standards can help anyone, from regulators to advocates, who want to ensure their state is better ensuring high-quality, evidence-based mental health care access and care.
“It really only takes a few advocates that are willing to dive into being parity experts in a state,” Finke said. “Every piece of the mental health puzzle, from the workforce shortages to issues like step-therapy and prescription medication access, is dependent on parity at the root.”
To take action on parity in your state, please:
- Request to join the State Parity Workgroup by email to learn about these topics more in-depth, connect with colleagues, and become your state expert.
- Sign up for email updates from The Kennedy Forum, so you will be the first to know when new Parity Gold Standards have arrived.
- Contact The Kennedy Forum if your state is creating or proposing legislation and you need additional information, guidance, analysis, or support.
