Virginia Regulations

The Virginia Bureau of Insurance requires plans to complete a checklist (pdf | Get Adobe® Reader®) that demonstrates how they comply with the parity sections of the state insurance law and the Federal Parity Law (the parity sections of the state insurance law is summarized at the bottom of this page under “Virginia Parity Law”). There are 4 categories relevant to parity in the checklist:

• Determining parity – plans are instructed that definitions for behavioral health conditions “must be consistent with generally recognized independent standards of current medical practice” (page 1)
• Financial requirements and quantitative treatment limitations (page 2)
• Non-quantitative treatment limitations (NQTLs) (page 3)
• Plan disclosure requirements to enrollees and providers (bottom of page 3)

Each of these categories has detailed instructions for how plans must comply with the relevant laws. Page 3 lists 9 different NQTLs and informs plans that “an NQTL must not be designed to restrict access to MH/SUD benefits.” This checklist is the same as the 3/2015 checklist.

The Virginia Bureau of Insurance issued an administrative letter (pdf | Get Adobe® Reader®) that provided summaries of insurance-related statutes enacted or amended during the 2015 legislative session. The letter summarizes SB 1747, which requires individual plans to provide mental health and substance use disorder benefits that are in parity with medical and surgical benefits. It also requires the Bureau of Insurance to develop reporting requirements for denied claims, complaints, and appeals.

The Virginia Bureau of Insurance issued an administrative letter (pdf | Get Adobe® Reader®) that withdrew a previous administrative letter. This letter clarified that recently-passed legislation had removed the language in the section of the state insurance law about autism coverage that exempted only small employer plans with 50 or fewer employees. Before this language was removed there was confusion on the part of insurers about what this would mean in January of 2016 when the definition of a small employer plan changes to a plan with 100 or fewer employees.

The Virginia Bureau of Insurance requires plans to complete a checklist (pdf | Get Adobe® Reader®) that demonstrates how they comply with the parity sections of the state insurance law and the Federal Parity Law (the parity sections of the state insurance law is summarized at the bottom of this page under “Virginia Parity Law”). There are 4 categories relevant to parity in the checklist:

• Determining parity – plans are instructed that definitions for behavioral health conditions “must be consistent with generally recognized independent standards of current medical practice” (page 1)
• Financial requirements and quantitative treatment limitations (page 2)
• Non-quantitative treatment limitations (NQTLs) (page 3)
• Plan disclosure requirements to enrollees and providers (bottom of page 3)

Each of these categories has detailed instructions for how plans must comply with the relevant laws. Page 3 lists 9 different NQTLs and informs plans that “an NQTL must not be designed to restrict access to MH/SUD benefits.” This checklist is the same as the 3/2016 checklist.

The Virginia Bureau of Insurance released Essential Health Benefits Guidance (pdf | Get Adobe® Reader®) – a document that helps insurers design plans in compliance with essential health benefit requirements. Section V on page 11 addresses mental health and substance use disorder services, including behavioral health treatment. In the comments section, the document specifies that insurers can not apply a quantitative treatment limitation, like day or visit limits, for behavioral health treatment if it is not also applied to medical/surgical benefits. The document goes on to comment on covered outpatient, inpatient, and residential treatment services for mental health and substance use disorders.

The Bureau of insurance released two separate market conduct examination reports. One was in regards to HealthKeepers, Inc. and the other was in regards to Priority Health Care Inc. Among many other things, the Bureau investigated both plans for its compliance with the parity sections of the state insurance law. The investigation revealed that both plans were using different copayments for some mental health services than for other medical services, thus making the plans technically non-compliant with the law. However, both plans strongly disagreed with this interpretation of the the state insurance law because the copayments they were using for mental health services were lower than those used for other medical services (emphasis added by ParityTrack). The Bureau conceded that this was true and did not take any punitive action (found on pages 26, 27, and 28 of the Priority report (pdf | Get Adobe® Reader®) and pages 27 and 28 of the HealthKeepers (pdf | Get Adobe® Reader®) report).

On page 7 of this report (pdf | Get Adobe® Reader®) from the Office of the Managed Care Ombudsman to the Virginia General Assembly there is a brief summary of the Parity The report also notes that retrospective market conduct examinations could reveal noncompliance with the Federal Parity Law by managed care organizations and “if that occurs, the Bureau will take appropriate action.”

The Virginia State Corporation Commission, Bureau of Insurance issued a regulation requiring large employer fully-insured plans issued by health maintenance organizations to cover behavioral health services “in accordance” with the Federal Parity Law (found on page 348-350 (pdf | Get Adobe® Reader®) or can be found under A.6 here).

The Bureau of insurance released a market conduct examination report investigating Peninsula Health Care Inc.. Among many other things, the Bureau investigated compliance with the parity sections of the state insurance law. The investigation revealed that Peninsula Health Care Inc., was using different copayments for some mental health services than for other medical services, thus making the plan technically non-compliant with the law. However, Peninsula Health Care Inc. strongly disagreed with this interpretation of the the state insurance law because the copayments they were using for mental health services were lower than those used for other medical services (emphasis added by ParityTrack). The Bureau conceded that this was true and did not take any punitive action (found on pages 26, 27, and 28 of the Peninsula Health Care Inc. report (pdf | Get Adobe® Reader®)).

The Virginia Bureau of Insurance issued an administrative letter (pdf | Get Adobe® Reader®) to insurance plans notifying them of the then recently-passed state bill SB 706 that amended the parity sections of the state insurance law and required large employer fully-insured plans to cover behavioral health services “in accordance” with the Federal Parity Law. It then informed them that while not required, plans were “strongly encouraged” to complete the Bureau’s parity checklist, which instructs plans to demonstrate how they comply with requirements of state and federal law relevant to parity (the most recent version of this checklist is summarized above on this page in the entry “3/2015” and is linked in that entry). In this letter you might notice a reference to a section of Virginia State Law, 38.2-3412.1:01. This law was about coverage requirements for “biologically-based mental illness” and was repealed in 2015 because amendments to the another section of the state insurance law made 38.2-3412.1:01 obsolete and irrelevant (that section is 38.2-3412.1 and is summarized at the bottom of this page under “Virginia Parity Law”). If you would like to know what was in 38.2-3412.1:01 please contact us at info@paritytrack.org.