Mental Health Parity in the
States
2007
|
State |
Statute/Code
Citation |
Relevant
Bills |
Covered
Population * |
Benefit |
Policies |
Exclusions |
|
|
Code
of AL §§27-54-1 to 27-54-7 (G/I) (2000) §10-4-115
(health care service plans) (2002) §27-21A-23
(HMOs) (2002) |
2000: HB
677 2002: SB
293 |
Full Coverage Mental illness: schizophrenia, schizophrenia form
disorder, schizoaffective disorder, bipolar disorder, panic disorder,
obsessive-compulsive disorder, major depressive disorder, anxiety disorders,
mood disorders, and any condition or disorder involving mental illness,
excluding alcohol and substance abuse that falls under mental disorders
listed in the ICD†. |
Mandated
Offering Coverage for the treatment and diagnosis of mental
illnesses under terms and conditions that are no less extensive than the
benefits provided for medical treatment for physical illnesses. Provisions for maximum benefits and
coinsurance and limitations, deductibles, exclusions, and utilization review
protocols must be consistent with the chapter. |
Group,
Individual, HMOs and health care service plans |
Group health
plans covering 50 or fewer employees |
|
|
No
Parity Law |
|||||
|
|
(1997) |
|
Coverage Defined by Plan Mental Illness |
Mandated if Offered Parity in aggregate annual and aggregate lifetime
limits; co-payments, limits on the number of visits or days, and medical
necessity criteria may be different |
Group |
Businesses with 50 or fewer employees; cost increase
of 1% or more |
|
|
(1997) |
Full Coverage Mental Illness and Developmental Disorders:
Illnesses and disorders listed in the ICD and the DSM††. |
Mandate (Group) No differences (compared to benefits for other
medical illnesses) with regard to duration or frequency of coverage, the
dollar amount of coverage, or financial requirements. Mandated Offering (Individual, small insurers) Same coverage as above |
Group Individual, plans for small insurers |
State employees, and businesses that anticipate a
cost increase of more than 1.5% |
|
|
|
(1973) |
|
Coverage Defined by Plan Mental and nervous disorders |
Mandated offering |
Group |
n/a |
|
|
(1999) |
1999: AB 88 |
Limited Coverage Severe mental illness: schizophrenia,
schizoaffective disorder, bipolar disorder, major depressive disorders, panic
disorder, obsessive-compulsive disorder, pervasive developmental disorder,
anorexia nervosa, bulimia nervosa.
Children with one or more mental disorders other than a primary
substance abuse disorder or developmental disorder. |
Mandate Coverage includes OP services, IP hospital services,
partial hospital services, and prescription drugs, if the policy or contract
includes coverage for prescription drugs.
Parity extends to maximum lifetime benefits, co-payments and coinsurance
and individual and family deductibles. |
Group, individual, HMO |
n/a |
|
|
CO
Rev. Stat. §§10-16-104(5-5.5) (1992, 1997) |
1997: HB 1192 2003: HB 1164
|
Coverage Defined by Plan Mental illness excluding autism Limited Coverage Biologically-based mental illness, including
schizophrenia, schizoaffective disorder, bipolar disorder, major depressive
disorder, and obsessive compulsive disorder. |
Mandate 45 IP days or 90 days of partial
hospitalization. $1,000 or 20 OP
visits. Co-payments and coinsurance
may be different but cannot exceed 50% of the payment. Deductibles may not differ from those for
other conditions Mandate (biologically based) Coverage must be no less extensive than coverage for
physical illness. |
Group |
Small employers providing coverage through a basic
health benefit plan |
|
|
(Substance Abuse) (2002) |
2002: HB
1263/Ch. 208 of 2002 |
Substance abuse |
Mandated If Offered Plan must cover voluntary or court-ordered treatment |
Group and individual |
n/a |
|
|
CT Gen. Stat. § 38a-488a
and (1999) |
1999: HB
7032 |
Broad Coverage All mental illnesses recognized by the most recent
edition of the DSM, including addictive disorders. Exceptions: mental retardation, learning
disorders, motor skills disorders, communication disorders, caffeine-related
disorders, relational problems and “additional conditions that may be the
focus of clinical attention, that are not otherwise defined as mental
disorders in the most recent addition” of the DSM. |
Mandate |
Group and individual |
n/a |
|
|
(1998, 2001) |
1998: HB
156 2001: HB
100 |
Limited Coverage Serious mental illness: schizophrenia, bipolar
disorder, obsessive-compulsive disorder, major depressive disorder, panic
disorder, anorexia nervosa, bulimia nervosa, schizoaffective disorder and
delusional disorder. Drug and alcohol
dependencies included in 2001. |
Mandate Coverage required under the same terms and
conditions of coverage offered for physical illnesses. No out of network coverage, benefit management
may be different than for physical illnesses. |
Group, individual, and HMO |
n/a |
|
|
(1999, 2006) Select “Update” at top of section |
|
Full Coverage Clinically significant mental illness: any
psychiatric disease identified in the most recent edition of the ICD or the
DSM. Substance abuse included. |
Mandate Minimum benefits: 60 IP days; minimum rate of 75%
for the first 40 OP visits and a minimum rate of 60% for any OP visits
thereafter. |
Group and individual |
n/a |
|
|
|
Full Coverage Mental and nervous disorders as defined in the
standard nomenclature of the American Psychiatric Association |
Mandated Offering Benefits (durational limits and dollar amounts) do
not need to be the same as those for physical illness once minimum benefits
are met. Minimum benefits: 30 IP
(including partial hospitalization) days and $1,000 in OP benefits |
Group and HMO |
n/a |
|
|
|
GA Code (Group- small employers) (Group- large employers) (Individual) (1998) |
1998: SB 620 |
Full CoverageMental disorders as defined by the DSM or the ICD, “or as the Commissioner may further define such term by rule and regulation. Substance abuse included.
|
Mandated
Offering Group- small:
Same degree of coverage and lifetime and annual dollar limits compared to
physical illness. Co-pays and
co-insurance must also be equal, but IP days and OP visits may be
different. Separate deductibles and
out-of-pocket maximums may be applied, but cannot be greater than those for
medical/surgical benefits Group- large: Same degree of coverage and lifetime
and annual dollar limits compared to physical illness. Co-pays, co-insurance, and visit limits
must also be equal Individual: Insurers not required to pay beyond 30 IP days and 48 OP visits. Exclusions, reductions, or other limitations as to coverages,
deductibles, or coinsurance must also apply to similar benefits. |
Group, individual
and HMO |
n/a |
|
|
HI
Rev. Stat. §431M to §431M-7 (1988, 1999,
2003, 2005) |
1999: SB 844 2003: SB 1321
2005: SB 761 |
Broad
Coverage Mental illness:
a syndrome of clinically significant psychological, biological, or behavioral
abnormalities that results in personal distress or suffering, impairment of
capacity for functioning, or both.
Does not include epilepsy, senility, mental retardation or other
developmental disabilities. Limited
Coverage Serious mental
illness: a mental disorder consisting of at least one of the following:
schizophrenia, schizo-affective disorder, bipolar types I and II, delusional
disorder, major depression, obsessive compulsive disorder, and dissociative
disorder as defined in the most recent version of the DSM and which is of
sufficient severity to result in substantial interference with the activities
of daily living. Substance abuse
included in a separate section. |
Mandate Mental illness: Deductibles and co-payments must be
equal to those for physical illnesses requiring a comparable level of
care. Minimum requirements: 30 IP
days, partial hospitalization/day treatment at least 30 visits per
year. OP services for SA and MH: at least 24 per year. At least
12 of those 24 visits must be for MH, not SA. At least 2 treatment
episodes for SA treatment per lifetime. Serious mental
illness: rates, terms, or conditions including service limits and financial
requirements must be equal to those for medical/surgical conditions. |
Group,
individual, and HMO |
Businesses with
25 or fewer employees |
|
|
2006: H.B. 615 |
Limited
Coverage Serious mental
illness and serious emotional disturbances: Schizophrenia, Paranoia and other
psychotic disorders, Bipolar disorders (mixed, manic, and depressive), Major
depressive disorders (single episode or recurrent), Schizoaffective disorders
(bipolar or depressive), Panic disorders, and Obsessive-Compulsive disorders. |
Mandate Services must be provided in a manner that: is not more restrictive or more generous than benefits and coverages provided for
other major illnesses; provides clinical care, but does not require partial
care, of serious mental illness
or serious emotional disturbance; and is consistent with effective and common
methods of controlling health care costs for other major illnesses. |
Group, State
employees only |
n/a |
|
|
|
IL
Rev. Stat. Ch. 215 Art. XX §5/370c (2nd version listed) (1991, 2001,
2005) |
2001: P.A.
092-0185 2005: P.A.
094-0584 2005: P.A.
094-0906 2005: P.A.
094-921 |
Coverage
Defined by Plan Mental,
emotional, or nervous disorders Limited
Coverage Serious Mental
Illness: schizophrenia; paranoia and other psychotic disorders; bipolar disorders
(hypomanic, manic, depressive, and mixed); major depressive disorders (single
episode or recurrent); schizoaffective disorder (bipolar or depressive);
pervasive developmental disorders; obsessive-compulsive disorders, depression
in childhood and adolescence; panic disorder; post-traumatic stress disorder
(acute, chronic, or with delayed-onset) |
Mandate (SMI)
|
Group and HMOs |
Businesses with
50 or fewer employees |
|
|
(1999, 2001) |
1999: HB 1108 2001: HB 1001 2003: HB 1135 |
Coverage
Defined by Plan Mental
illness. “Services for mental
illnesses” as defined by a contract, policy, or plan for health
services. Substance abuse treatment
for those with mental illnesses added in 2001. |
Mandated
if Offered Treatment
limitations and financial requirements must be equal to medical and surgical
conditions. |
Group,
individual |
Businesses with
50 or fewer employees, or a cost increase of 4% or more |
|
|
(State Employee
Plan, 1997) |
|
Coverage
Defined by Plan Mental
illness. “Services for mental
illnesses” as defined by a contract, policy, or plan for health
services. Substance abuse treatment
for those with mental illnesses included. |
Mandated
if Offered Treatment
limitations and financial requirements must be equal to medical and surgical
conditions. |
State employees |
Cost increase of
4% or more |
|
|
(2005)</ | |||||