Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

The Mental Health Association of Southeastern Pennsylvania (MHASP)

Name of Innovative Program: 
The Pennsylvania Insurance Equity Project (PIEP)
Sponsoring Organization
The Mental Health Association of Southeastern Pennsylvania (MHASP)
Name of Innovative Program Lead: 
Adam Nester
E-mail Address of Innovative Program Lead: 
anester@mhasp.org
Physical Address of Innovative Program: 
1211 Chestnut Street, 11th Floor Philadelphia, PA 19107
Project Description: 
The Mental Health Parity and Addictions Equity Act of 2008 (“Parity”) afforded citizens groundbreaking new rights in access to behavioral health treatment. Unfortunately, inadequate public awareness of the law results in persistent Parity violations throughout insurance systems. 
 
The Pennsylvania Insurance Equity Program (“PIEP”) at MHASP works toward the implementation and enforcement of Parity to increase timely access to high-quality behavioral healthcare. PIEP strives to meet this goal using interventions at the individual, community, and systems levels.
 
PIEP consists of a statewide parity hotline that helps individuals file parity complaints, a free training for community groups, an educational advocacy portal and print materials that raise awareness among the public of their rights under the law, and advocacy to elected officials and administrators that transforms the system to become more Parity compliant.
 
How does the innovative program work to improve behavioral health access?: 

PIEP promotes the enforcement of Parity by providing free education and advocacy services to Pennsylvania residents. Qualitative Parity violations persist in our insurance systems including restrictive utilization review requirements, refusal to share medical necessity criteria, and inadequate provider networks. These violations create barriers to receiving timely care, with many consumers waiting months before their first interaction with a psychiatrist or other treatment provider.

PIEP works with consumers and families to educate them on their rights and assists them in filing appeals to their insurer and grievances to the state and federal governments. Expanding true Parity enforcement will reduce wait time for services through a more equitable and adequate provider network, and promote an increase in treatment options that are available to consumers. Comprehensive enforcement of behavioral healthcare parity will create a dramatic increase in behavioral healthcare access.

How does the innovative program work to improve behavioral health quality? : 
PIEP at MHASP provides assistance to consumers to determine if Parity applies to their insurance plan and if there is a potential violation, and then works with them to file timely appeals. It is our hope that this intervention will meet two goals: 
  1. Assist individuals to obtain necessary and timely care and 
  2. Inform the state and federal authorities as to which parity violations are most commonly occurring, resulting in increased enforcement and ultimately compliance with Parity. 
The comprehensive implementation of Parity will result in improved behavioral healthcare through increased availability of funds from the private insurance system.
 
How does the innovative program work to address behavioral health costs? : 
The work of PIEP at MHASP has the potential to reduce behavioral healthcare costs in Pennsylvania in several ways. 
 
Changes that expand the ability of consumers to use their private insurance at the community level in a timely way, before they experience a crisis, will reduce costs through the use of lower-level interventions and more preventive care. 
 
Additionally, the ability to access adequate care through private insurance will lead to reduced reliance on state-funded emergency systems and fewer disruptions in their economic and family structures. When people are able to access care in a timely manner, they will be more likely to continue working and not be forced to reduce their income in order to qualify for public benefits. 
 
The work of PIEP will reduce reliance on secondary payment sources such as Medicare and Medicaid, as insurers fund more of the types of care that they are required to cover under law. 
 
Creativity and Innovation: 
PIEP at MHASP is the first program that addresses the implementation of Parity in Pennsylvania at the individual, community, and systems levels. PIEP is unique in that it addresses Parity issues using a comprehensive three-track approach:
 
  • Educate the public (consumers, family members, and treatment providers) across the state about Parity rights and the treatment individuals are entitled to under the law through trainings, the website, and widely distributed educational materials;
  • Assist the public to receive the care they are entitled to under the law by filing grievances and appeals with insurers, state government, and the federal government as necessary;
  • Educate and advocate to key stakeholders in the Pennsylvania General Assembly, the Department of Insurance, and the Department of Human Services on the policies and best practices (including monitoring legislation and regulation) needed to ensure full Parity implementation and enforcement across the state. 
 
Leadership: 
MHASP has been working to raise awareness about Parity since 2012. Uncertainty as to what Parity implementation and enforcement should look like at the state level hindered these efforts. In 2013, the federal government issued clarification regarding Parity’s scope and released final guidelines in 2015. 
 
PIEP provides the only hotline to address Parity enforcement statewide. PIEP has been monitoring efforts in other states, adopting best practices, and developing new initiatives to address the needs of Pennsylvanians given its insurance marketplace. MHASP works collaboratively with coalition partner organizations to advocate for Parity enforcement.  MHASP encourages organizations to replicate its efforts in underserved communities, developing stakeholder partnerships statewide. It has noticed increased public interest and legislative attention as a result of its efforts, and believes its efforts can be replicated in other states.    
 
Sustainability: 
Since its inception, PIEP has worked closely with members of the national ParityTrack (www.paritytrack.org) project to ensure that MHASP’s efforts in Pennsylvania align with the national effort to get Parity enforced in all 50 states. This collaboration has resulted in MHASP’s selection by ParityTrack as a designated partner in Pennsylvania on its website and promotional materials. 
 
MHASP has provided institutional support for PIEP’s efforts, funding a web domain, office space, and providing telephonic resources for a statewide hotline that consumers call to discuss potential Parity issues.
 
MHASP has also supported the design and printing of educational materials that have been distributed at more than 100 healthcare provider locations across the state.
 
Replicability: 
MHASP continues to share its experiences running a Parity assistance center with other organizations across the state with to foster regional advocacy centers that can assist with Parity issues. MHASP is evaluating best practices from other states, and translating those competencies to develop recommendations for best practices within Pennsylvania’s institutions, notably the Human Services and Insurance departments.
 
As part of its collaboration with ParityTrack, MHASP has agreed to share best practices and contribute analyses so that PIEP can eventually help provide technical assistance to Parity Implementation Coalitions as they develop in other states.
 
MHASP shared its lessons learned and best practices with a national audience at the New York Association of Psychiatric Rehabilitation Services Providers conference in 2016. PIEP discussed the Parity movement and gave advice on how to establish a Parity Implementation Coalition in other states. 
Results/Outcomes: 
MHASP continues to adapt the program as it consults with consumers and gains more experience as to the types and frequency of Parity issues they are encountering. The success of the program can be measured by increased engagement with the public, legislators, and institutional stakeholders. MHASP measures the number and frequency of its outreach efforts (e.g., events attended, number of people engaged and provided with Parity information).
 
MHASP provides Parity trainings to providers, families, and consumers. MHASP is developing metrics, including pre- and post-tests, to evaluate how well training participants are retaining Parity information and continues to refine its processes as new information as to the impact of its Parity efforts develops.
 
Increased public awareness can be measured by PIEP participation in public hearings and forums as well as attention to the program in the media. PIEP has recently been featured by the Philadelphia Inquirer. 
 
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