Seeking Clarity for Parity: A New Era for Parity Legislation, Litigation, and Enforcement (2020 Health Plan Single Session)

4. Seeking Clarity for Parity: A New Era for Parity Legislation, Litigation, and Enforcement (Single Session Taken from the 2020 Health Plans Program)

Gerald (Jud) E. DeLoss, Todd Pearson and David Shillcut

The volume of new legislation, litigation, and regulatory enforcement regarding mental health and substance use disorder parity has exploded over the course of the past two years, but substantial confusion and debates persist regarding many of the most fundamental concepts. There is a significant need for health care attorneys with a sophisticated understanding of the structure and requirements of federal and state parity laws to assist stakeholders from all parts of the health care system strive to improve health care access and outcomes for individuals with mental health and substance use disorder needs.

  • Key developments among the sea changes to parity compliance and enforcement, with particular emphasis on the implications for provider contracting, utilization management, and pharmacy benefits
  • Legislative and regulatory developments
    • Current enforcement authority and approach by market
    • Federal legislation is proposed that would require health plans to develop and implement dedicated parity compliance programs
  • Litigation and regulatory enforcement
    • Significant enforcement actions and multi-million dollar settlements have recently made headlines in states across the country
    • Courts are dramatically expanding the conceptual framework and compliance requirements for health plans and coverage to adhere to national standards of care
    • Public and private litigation is pushing requirements for provider reimbursement rates and methodologies to adhere to parity requirements that are poorly defined in guidance and hotly disputed among stakeholders
  • Best practices for compliance
    • Ambiguities in guidance and differences in enforcement approaches across markets and regulators can pose challenges to demonstrating and determining compliance
Continuing Education Credits are available for this session. For CLE credits, you can earn 1.0  credit hours on a 60-Min Calculation and 1.2 credit hours on a 50-minute Calculation. For CPE and CCB, you can earn 1.2 credit hours for this session.