One of the goals of ParityTrack is to rate the steps that states are taking towards parity implementation in terms of legislation, regulation, and litigation. As ParityTrack evolves so too will the rating criteria, both in terms of precision and scope.
The Federal Parity Law is an important mechanism for parity compliance and state laws can also provide another means of helping consumers of behavioral health services get the care they deserve. Please keep in mind that the ParityTrack rating system does not intend to imply necessarily that legislation, regulatory actions, and litigation are of equal value towards achieving parity compliance.
Currently there are three rating scores:
Needs work (Black)
Neutral (Gray)
Promising (Yellow)
Legislative Rating Criteria
(12 points possible. 1-4 = needs work; 5-8 = neutral; 9-12 = promising)
The overarching theme of these criteria is ‘Does this state’s law(s) regarding behavioral health insurance coverage require parity, and to what degree of specificity?’ These criteria also include any steps (successful or unsuccessful) taken to bolster the existing state law(s). Criteria include:
Is this a comprehensive parity law?
Has legislation been introduced to make the law a comprehensive parity law?
Does the state law apply to all behavioral health conditions?
Has legislation been introduced to make the law apply to all behavioral health conditions?
Does state law explicitly address quantitative treatment limitations and financial requirements?
Has legislation been introduced to explicitly address quantitative treatment limitations and financial requirements?
Does state law explicitly address non-quantitative treatment limitations?
Has legislation been introduced to explicitly address non-quantitative treatment limitations?
Does state law explicitly address intermediate levels of care?
Has legislation been introduced to explicitly address intermediate levels of care?
Are regulatory procedures explicitly described in the law (enforcement authority, fines, reporting procedures, etc.)?
Has legislation been introduced to explicitly describe regulatory procedures in the law?
Are you involved in the legislative process or someone with thoughts as to how these criteria could evolve? Email us at info@paritytrack.org.
Regulatory Rating Criteria
(10 points possible. 1-3 = needs work; 4-6 = neutral; 7-10 = promising)
The overarching theme of these criteria is ‘Does the state have infrastructure in place to regulate parity compliance, are they actively taking steps to regulate parity compliance, and have they created additional regulations or further defined elements of the state law?’ Criteria include:
Has a state agency issued regulations regarding parity laws?
Has a state agency issued interpretive opinions on parity laws?
Has a state agency issued any bulletins or guidance letters on parity laws?
Has a state agency investigated potential parity violations?
Does a state agency regularly investigate potential parity violations?
Has a state agency levied fines against an issuer for parity violations?
Have other punitive actions been taken by a state (revocation or suspension of accreditation or certification, for example)?
Has a state agency made its regulatory actions public?
Does a state agency require insurance plans submit reports demonstrating compliance with the Federal Parity Law and similar state laws?
Has a state agency actively responded to consumer complaints about potential parity violations?
Are you someone within a state regulatory agency or someone with thoughts as to how these criteria could evolve? Email us at info@paritytrack.org.
Litigation/Judicial Rating Criteria
(7 points possible. 1-2 = needs works; 3-4 = neutral; 5-7 = promising)
The overarching theme of these criteria is ‘What actions have been taken in the realm of litigation to address parity violations, and have courts interpreted state and federal parity laws in ways that support or expand parity laws?’ Criteria may include:
Has there been any private litigation initiated in response to parity violations?
Have there been out of court settlements for privately-initiated parity cases?
Has any litigation been brought by the attorney general/government?
Have there been out of court settlements for government-initiated parity cases?
Have courts imposed damages for parity violations?
Have courts issued injunctions or other remedies for parity violations?
Have courts interpreted parity laws in a manner that is consistent with a comprehensive parity law (e.g. by including additional behavioral health conditions not enumerated in the law, stating that all insurance contracts should be interpreted in favor of the consumer, etc)?
Are you an attorney or someone with thoughts as to how these criteria could evolve? Email us at info@paritytrack.org.