Table 3.
Summary of themes and subthemes
| Theme | Description | Sample Quote |
|---|---|---|
| Relationships | ||
| With other state offices | Formal and informal relationships with other state government agencies | There’s lots of areas where we have overlapping jurisdiction and it’s really just a matter of coordination to decide who has the tools that are most effective to solve this problem and if both sets of tools are necessary, then we might proceed in parallel |
| With advocates and professional organizations | Communication and informal relationships with MH/SUD advocacy and professional organizations | My organization has been meeting with [the Division of Insurance] about mental health parity implementation since 2014… |
| With insurers | Working relationship with insurers selling plans within their state | We kind of make a habit of not denying filings, we want to work with the company to get the best possible product out to our consumers. |
| Policy Complexity | ||
| Interpretation of the law | Lack of clarity about the meaning or application of parts of MHPAEA | I think the hardest part for everyone is knowing what parity specifically means and I think we do understand that there is guidance from the federal government, but even some of that guidance is confusing |
| Necessary expertise | Required legal or content knowledge to understand or enforce MHPAEA | We did reach out to clinical advisors, but to have someone with that area of expertise, which is pretty specialized to, look at the criteria and evaluate it and give us their opinions both on the criteria or how the criteria are being applied, and then to give us an opinion on parity issue too. |
| Public education | Public knowledge of applicability and protections under MHPAEA | People didn’t understand that we had both state and federal mental health parity laws that we’re required to abide by and that without that public education patients weren’t adequately advocating for themselves |
| Political Priority | Prioritization of enforcement of MHPAEA by insurance commissioners’ offices, legislators or other political actors | It kind of depends on the individual and what their aspirations or are they just put in the position to hold a spot or are they someone who’s gung-ho and really wants to be involved. |