PID employee earns award for mental health work

This week, Governor Josh Shapiro presented Lindsi Swartz, Pennsylvania Insurance Department's (PID) Director for the Life, Accident and Health Insurance Bureau, with the Governor's Award for Excellence for her state and national leadership surrounding mental health parity compliance and access to autism services through insurance coverage.

Health insurance companies that offer mental health benefits are required by state law to provide Pennsylvania consumers with the same level of health insurance coverage for mental health and substance use disorder treatment as they do medical/surgical services. Pennsylvania has been a national leader in ensuring its regulated insurance community complies with state and federal law.

"Governor Shapiro charged PID with leading the way on making mental health parity a true reality in Pennsylvania, and I'm proud to say that Lindsi has helped PID make big strides to accomplish this goal," said Pennsylvania Insurance Commissioner Michael Humphreys. "Lindsi's dedication to prioritizing parity enforcement across the Commonwealth is unmatched. PID is grateful for the work she has done on behalf of consumers, and we are fortunate to have such an outstanding public servant working for the people of Pennsylvania. Not only that, but Lindsi's efforts have also impacted the national conversation on how state insurance regulators can best oversee parity in our respective insurance markets."

Swartz was recognized for developing a new mental health parity validation and assessment review process for insurance policies before they are available for sale to consumers, so that insurers can address parity compliance issues before they impact consumers or become consumer complaints.

With a goal to identify how insurers were complying with parity requirements and how plans define mental health benefits (such as defining autism spectrum disorders), Lindsi and her team tested over a thousand plan designs that cover more than 2.5 million Pennsylvanians. Her research and analysis became the foundation for Autism Spectrum Disorders Coverage and Parity in November 2023, requiring commercial insurers to consistently define autism services as mental health benefits for the purpose of parity analysis.

Additionally, following PID's bulletin, Swartz led a team that helped insurers make sure their policy forms and analyses were updated to capture autism benefits accurately. PID can now ensure that autism is treated consistently by health insurers subject to the notice so that consumers have full parity protections. In some instances, cost-sharing limitations like copay or coinsurance, session or visits limits, age limitations or requirements like prior authorization were removed for certain services in Pennsylvania, improving access to autism benefits for Pennsylvanians who purchase those health insurance plans.

Swartz also played a critical role in solidifying Pennsylvania's position as a leader in mental health parity review by creating a template that now serves as a national model for other state regulators to identify and close compliance and enforcement gaps. These templates have also been shared at the National Association of Insurance Commissioners (NAIC) Mental Health Parity Working Group, and the templates were cited in the Technical Release issued by the U.S. Departments of Treasury, Labor, and Health and Human Services as a best practice for other states to consider.

Swartz's commitment to consumer protection and analysis of insurer data lead to PID's inaugural Transparency in Coverage (TiC) Report last October. This report highlights the importance of appeal rights when insurance companies deny claims and continues to serve as a valuable resource for Pennsylvanians to learn more about PA health plans.

The Governor's Awards for Excellence recognize Commonwealth employees for exemplary job performance or service that reflects initiative, leadership, innovation and/or increased efficiency. A total of 56 employees from 12 agencies received awards for accomplishments in 2023.

Learn more about PID online. Consumers may contact PID's Bureau of Consumer Services to file a complaint online or call 1-877-881-6388. For more information on the Shapiro Administration's commitment to supporting Pennsylvanians with autism, visit pa.gov/autism.