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) |
2005: HB 420 (Under HF
420) |
Limited Coverage Biologically based
mental illness: schizophrenia, bipolar disorders, major depressive disorders,
schizo-affective disorders, obsessive- compulsive disorders, pervasive
developmental disorders, and autistic disorder |
Mandate Annual and lifetime
limits as well as deductibles, coinsurance and co-payments must be equal
those for medical/surgical coverage.
At minimum, a plan must provide 30 IP days and 52 OP visits. |
Group |
Businesses with 50 or
fewer employees |
|
|
(1998, 2001,
2003) |
2001: HB 2033 |
Full
Coverage Alcoholism, drug
use, mental or nervous conditions. “Nervous or mental conditions"
refers to disorders specified in the DSM. |
Mandate Minimum
benefits: 30 IP days and reimbursement for treatment at: 100% of the first
$100, 80% of the next $100, and 50% of the next $1,640 in a year, and $7,500
in a lifetime. |
Group,
individual, HMO, state employees |
High deductible
plans |
|
|
KY Rev. Stat. §§
304.17A.660-669 (2000, 2002) |
2000: HB 268 |
Full Coverage Mental health
condition: any condition or disorder that involves mental illness or alcohol
and other drug abuse that falls under any of the diagnostic categories listed
in the DSM or that is listed in the mental disorders section of the ICD. |
Mandated
if Offered Coverage for
mental health conditions must be under the same terms and conditions as
coverage for physical health conditions.
“Terms and conditions”: day or visit limits, episodes of care, any
lifetime or annual payment limits, deductibles, co-payments, prescription
coverage, coinsurance, out-of-pocket limits, and any other cost-sharing
requirements. |
Group |
Plans covering
51 or fewer employees |
|
|
(1982, 1999) |
1999: SB
419 |
Limited
Coverage Severe mental
illness: Schizophrenia or
schizoaffective disorder, bipolar disorder, pervasive developmental disorder
or autism, panic disorder, obsessive-compulsive disorder, major depressive
disorder, anorexia/bulimia, Asperger's Disorder, intermittent explosive
disorder, posttraumatic stress disorder, Psychosis NOS (not otherwise
specified) when diagnosed in a child under seventeen years of age, Rett's
Disorder, Tourette's Disorder. Full Coverage Optional coverage for mental disorders other than severe mental
illnesses. |
Mandate (SMI) Minimum
benefits: 45 IP days and 52 OP visits. Mandated
Offering (other
mental disorders). Benefits shall
be payable under the same circumstances
and conditions as benefits are paid for all other diagnoses, illnesses, or
accidents. |
Group, HMO,
state employees |
n/a |
|
|
(1982) |
|
Alcoholism and
drug abuse |
Mandated
Offering Benefits not
specified |
Group |
n/a |
|
|
(1996, 2003) |
2003: HB 973 |
Limited
Coverage Mental illness:
Psychotic disorders, including schizophrenia; dissociative disorders; mood
disorders; anxiety disorders; personality disorders; paraphilias; attention
deficit and disruptive behavior disorders; pervasive developmental disorders;
tic disorders; eating disorders, including bulimia and anorexia; and
substance abuse-related disorders.
Does not include V Codes. |
Mandate Terms and
conditions no less extensive than the benefits provided for medical treatment
for physical illnesses. There may not
be separate maximums, deductibles, coinsurance amounts, out-of-pocket limits,
or office visit limits. Co-payments
must be actuarially equivalent to any coinsurance requirements or, if there
are no coinsurance requirements, may not be greater than any co-payment or
coinsurance required under the policy or contract for a benefit or coverage
for a physical illness |
Group |
Businesses with
20 or fewer employees |
|
|
ME
Rev. Stat. Tit. 24- §2325A (5-D) (1996) |
|
Limited
Coverage Schizophrenia;
bipolar disorder; pervasive developmental disorder, or autism; paranoia; panic
disorder; obsessive-compulsive disorder; or major depressive disorder. |
Mandated
Offering Benefits must be
under terms and conditions that are no less extensive than the benefits
provided for medical treatment for physical illnesses. Policies may contain provisions for maximum
benefits and coinsurance and reasonable limitations, deductibles and
exclusions to the extent that these provisions are not inconsistent with the
requirements of this section. |
Group and
individual |
n/a |
|
|
(1993, 2005) |
1993: HB 1359 |
Coverage
Defined by Plan Mental illness,
emotional disorder, drug abuse disorder, or alcohol abuse disorder |
Mandate Must provide
benefits under the same terms and conditions that apply to physical
illness. At a minimum: IP benefits
must be the same; at least 60 days of partial hospitalization; OP benefits
cannot be less than 80% for visits 1-5, 65% for visits 6-30, and 50% for
visits over 30. |
Group, individual,
and HMO |
n/a |
|
|
|
Medically
necessary residential crisis services |
Residential
crisis services as alternative to IP |
Group,
individual, HMO, and nonprofit health service plans |
n/a |
|
|
|
(1993, 2000) for
State Employees (1996, 2000) |
2000: SB 2036 |
Broad
Coverage Biologically-based
mental disorders: schizophrenia, schizoaffective disorder, major depressive
disorder, bipolar disorder, paranoia and other psychotic disorders,
obsessive-compulsive disorder, panic disorder, delirium and dementia, affective
disorders, and any biologically-based mental disorders appearing in the DSM
that are scientifically recognized and approved by the commissioner of the
department of mental health in consultation with the commissioner of the
division of insurance. Parity for
alcohol and chemical dependency only when treated in conjunction with a
mental disorder Limited
Coverage Diagnosis and
treatment of rape-related mental or emotional disorders to victims of a rape
or victims of an assault with intent to commit rape whenever the costs of
such diagnosis and treatment exceed the maximum compensation awarded to such
victims. Broad
Coverage Coverage for
children and adolescents under the age of 19 for the diagnosis and treatment
of non-biologically-based mental, behavioral or emotional disorders, which
substantially interfere with or substantially limit the functioning and
social interactions of such a child or adolescent. Broad
Coverage Coverage for
other mental disorders not listed above but described in the DSM |
Mandate Benefits must be
provided on a non-discriminatory basis: annual or lifetime dollar or unit of
service limitation must be equal to limitations on the coverage of physical
conditions Mandate, see above Mandate, see above Mandate
Medically
necessary benefits: minimum of 60 inpatient days and 24 outpatient visits |
State employees;
Group, individual, and HMO |
n/a |
|
|
(1956, 2000) |
2000: SB
1209 |
Coverage
Defined by Plan Mental health
and substance abuse |
Mandate Charges, terms,
and conditions for the services required to be provided shall not be less
favorable than the maximum prescribed for any other comparable service. Outpatient
mental health only, minimum of 20 visits per year. Substance abuse:
a minimum of $2,968.00 in services for intermediate and outpatient care for
substance abuse per individual per year (minimum adjusted annually). |
HMO: group and
individual contracts |
Cost increase of
3% or more |
|
|
(1995) |
1995: SB 845 |
Coverage
Defined by Plan Mental health
and chemical dependency |
Mandated
if Offered Cost-sharing and
service limitations for IP and OP services must not place greater financial
burden or be more restrictive than other medical services. Mandate (HMOs) |
Group,
individual, and HMO |
n/a |
|
|
MN
Stat. §62A.152 (mental health) MN
Stat. §62A.149 (substance abuse) |
|
Mental health
and chemical dependency |
Mandated
if Offered
(mental health) Any plan that
has an inpatient benefit MUST also have an outpatient benefit with limits the
same as other services and co-pays limited to 20% for first 10 hours/year and
25% for any additional treatment. Prior authorization is also permitted
beyond the first 10 hours of treatment Full
Parity
(substance abuse) Payment of
benefits for the treatment of alcoholism, chemical dependency or drug
addiction to any |
Group, (MH);
Group and individual (SA) |
n/a |
|
|
(1975, 2001) |
|
Full
Coverage Clinically
significant mental illness: any
psychiatric disease identified in the current edition of the ICD or the DSM |
Mandate Minimum of 30 IP
days, 60 days for partial hospitalization, and 52 OP days. The rate of payment for IP services and
partial hospitalization shall be the same as provided for any other condition. The rate of payment for OP visits shall be
a minimum of 50% of covered expenses which may be limited to a maximum
payment of $50.00 per visit. |
Group and
individual |
Cost increase of
1% or more |
|
|
MO Rev. Stat.
Title XXIV §376.811 (1997, 2004) |
2004: HB 855 |
Full
Coverage Recognized
mental illness: those conditions classified as "mental disorders"
in the DSM, not including mental retardation.
Includes substance abuse. |
Mandated Offering Outpatient,
residential and inpatient treatment.
Coverage and benefits shall be subject to the same coinsurance,
co-payment and deductible factors as apply to regular office visits under
coverages and benefits for physical illness |
Group,
individual, and HMO |
n/a |
|
|
MO Rev. Stat. Title XXIV
§§376.825-376.840 (1997, 1999,
2004) Expires January
1, 2011 |
1999: HB 191 2004: HB 855 |
Limited
Coverage Mental illness:
schizophrenic disorders and paranoid states; major depression, bipolar
disorder, and other affective psychoses; obsessive compulsive disorder,
post-traumatic stress disorder and other major anxiety disorders; early
childhood psychoses and other disorders first diagnosed in childhood or
adolescence; alcohol and drug abuse; anorexia nervosa, bulimia and other
severe eating disorders; and senile organic psychotic conditions |
Mandated
if Offered Coverage shall
not establish any rate, term, or condition that places a greater financial
burden on an insured for access to evaluation and treatment for mental
illness than for access to evaluation and treatment for physical
conditions. Deductibles, co-payment or
coinsurance amounts for access to evaluation and treatment for mental illness
shall not be unreasonable in relation to the cost of services provided. Substance abuse:
minimum 30 days IP, 20 visits OP |
Group and
individual |
Cost increase
that results in a 2% increase in premium costs to the policyholder |
|
|
(2000) |
1999: SB 219 |
Limited Coverage Severe mental illness:
schizophrenia, schizoaffective disorder, bipolar disorder, major depression,
panic disorder, obsessive-compulsive disorder and autism. |
Mandate Coverage that is
no less favorable than that level provided for other physical illness
generally. Benefits include but are
not limited to: IP services, OP services, rehabilitative services, and medication. |
Group,
individual, and HMO |
n/a |
|
|
MT code Ann.
§33-22-701 to 705 (1997, 2001) |
|
Broad
Coverage Mental illness:
a clinically significant behavioral or psychological syndrome or pattern that
occurs in a person and that is associated with: present distress or a painful
symptom; a disability or impairment in one or more areas of functioning; or a
significantly increased risk of suffering death, pain, disability, or an
important loss of freedom. Mental illness
must be considered as a manifestation of a behavioral, psychological, or
biological dysfunction in a person.
Mental illness does not include: a developmental disorder; a speech
disorder; a psychoactive substance use disorder; an eating disorder, except
for bulimia and anorexia nervosa; an impulse control disorder, except for
intermittent explosive disorder and trichotillomania. |
Mandate Benefits
consisting of durational limits, dollar limits, deductibles, and coinsurance
factors that are not less favorable than for physical illness generally. Exceptions: 21 days maximum for IP;
$6,000/year until a lifetime maximum of $12,000 is met, then coverage reduced
to $2,000/year |
Group |
n/a |
|
|
(1999, 2002) |
1999: L 355 |
Broad
Coverage Serious mental
illness: any mental health condition that current medical science affirms is
caused by a biological disorder of the brain and that substantially limits
the life activities of the person with the serious mental illness. Includes, but is not limited to:
schizophrenia, schizoaffective disorder, delusional disorder, bipolar
affective disorder, major depression, and obsessive-compulsive disorder. |
Mandated
if Offered Plans shall not
establish any rate, term, or condition that places a greater financial burden
on an insured for access to treatment for a serious mental illness than for
access to treatment for a physical health condition. (Rate, term, or condition means lifetime
limits, annual payment limits, and inpatient or outpatient service limits.
Rate, term, or condition does not include any deductibles, co-payments, or
coinsurance). |
Group and HMO |
Businesses with
15 or fewer employees |
|
|
NV Rev Stat. (1999) §§ 689A.0455
(Individual) 689B.0359 (Group) (Nonprofit
corps.) (HMO) |
1999: SB 557 |
Limited
Coverage Severe mental
illness: schizophrenia, schizoaffective disorder, bipolar disorder, major
depressive disorder, panic disorder, and obsessive-compulsive disorder. |
Mandate Minimum 40 IP
days and 40 OP visits, excluding visits for medication management. Deductibles and co-payments must not be
greater than 150% of out-of-pocket expenses for medical and surgical
benefits. |
|
|
|
|
(Group and
individual) (1993, 2002) (HMO) |
|
Broad
Coverage Mental illness
and emotional disorders: mental disorders, as defined in the most recent
edition of DSM, excluding those disorders designated by a "V Code'' and
those disorders designated as criteria sets and axes provided for further
study in the DSM. Statute includes
coverage of substance abuse. |
Mandate Coverage for:
the treatment of mental illnesses which are subject to improvement through
short-term therapy, and diagnosis and evaluation of all other mental
illnesses. Policies must cover
substance abuse up to a specified limit, and must include IP and OP. Non-major
medical plans covering hospital expenses: benefits must be at least as favorable
as benefits for other illnesses. Non-major
medical plans covering medical expenses: the ratio of benefits to fees for
mental illness must be substantially the same as the ratio of benefits to
fees for other illnesses. Major medical
plans: subject to deductibles and coinsurance at least as favorable as
benefits for any other illness.
Benefits payable for expenses incurred in any consecutive 12-month
period may be limited to an amount not less than $3,000 per covered
individual, and to a lifetime maximum of not less than $10,000 per covered
individual. |
Group,
individual and HMO |
n/a |
|
|
(1994, 2002) |
1994: SB 767 2002: HB 672 |
Limited
Coverage Biologically-based
mental illnesses: schizophrenia and other psychotic disorders,
schizoaffective disorder, major depressive disorder, bipolar disorder,
anorexia nervosa and bulimia nervosa, obsessive-compulsive disorder, panic
disorder, pervasive developmental disorder or autism, and chronic
post-traumatic stress disorder. |
Mandate Benefits begin
after above benefits have been exhausted.
Benefits for treatment and diagnosis of certain biologically-based
mental illnesses under the same terms and conditions and which are no less
extensive than coverage provided for any other type of health care for
physical illness |
Group |
n/a |
|
|
(1999) |
1999: SB 86 |
Broad
Coverage Biologically-based
mental illness: a mental or nervous condition that is caused by a biological
disorder of the brain and results in a clinically significant or
psychological syndrome or pattern that substantially limits the functioning
of the person with the illness, including but not limited to, schizophrenia,
schizoaffective disorder, major depressive disorder, bipolar disorder,
paranoia and other psychotic disorders, obsessive-compulsive disorder, panic
disorder and pervasive developmental disorder or autism |
Mandate Coverage under
the same terms and conditions as provided for any other sickness under the
contract (co-payments, deductibles, and benefit limits must be equal to those
for medical/surgical benefits). |
Group and
individual |
n/a |
|
|
(2000) |
2000: HB
452 |
Limited
Coverage Mental health
benefits as described in the
group health plan, or group health insurance offered in connection with the
plan. Does not include substance
abuse, chemical dependency or gambling addiction. |
Mandate The plan shall
not impose treatment limitations or financial requirements on the provision
of mental health benefits if identical limitations or requirements are not
imposed on coverage of benefits for other conditions |
Group |
Businesses with
2-49 employees with a cost increase of more than 1.5% may: pay the increase,
negotiate cost-sharing, negotiate a reduction in coverage, or remove the
coverage completely if the cost increase was due solely to MH benefits. Over 50 employees: same conditions as above
if a cost increase of more than 2.5% |
|
|
(1998, 2006) |
2006: A 2912 |
Coverage
Defined by Plan Mental, nervous,
or emotional disorders or ailments Limited
Coverage Biologically
based mental illness: schizophrenia/psychotic disorders, major depression,
bipolar disorder, delusional disorders, panic disorder, obsessive compulsive
disorder, bulimia, and anorexia. Children with
SED: attention deficit disorders, disruptive behavior disorders, or pervasive
developmental disorders where there are one or more of the following: serious
suicidal symptoms, significant psychotic symptoms, behavior caused by
emotional disturbances that placed the child at risk of personal injury,
property damage or removal from the household. |
Mandate Mental health
treatment: 30 IP days and 20 OP days.
Deductibles and coinsurance must be consistent with those imposed on
other benefits. Biologically
based and SED: Coverage shall be provided under the terms and conditions
otherwise applicable under the policy, including network limitations or variations,
exclusions, co-pays, coinsurance, or deductibles. Out-of-network benefits and cost sharing
may be different than in-network benefits and cost sharing. |
Group and HMO |
Businesses with
50 or fewer employees: exempt from covering biologically based mental illness
and SED in children, but may opt to provide coverage. These groups are also subsidized by the
state for mental health treatment. |
|
|
(1991, 1997) |
1991: HB 279 1997: HB 435 |
Broad
Coverage Mental illness
and chemical dependency. "Mental
illness" means: (i) when applied to an adult, an illness which so
lessens the capacity of the individual to use self‑control, judgment,
and discretion in the conduct of his affairs and social relations as to make
it necessary or advisable for him to be under treatment, care, supervision,
guidance, or control; and (ii) when applied to a minor, a mental condition,
other than mental retardation alone, that so impairs the youth's capacity to
exercise age adequate self‑control or judgment in the conduct of his
activities and social relationships so that he is in need of treatment. The term
"chemical dependency" means the pathological use or abuse of
alcohol or other drugs in a manner or to a degree that produces an impairment
in personal, social or occupational functioning and which may, but need not,
include a pattern of tolerance and withdrawal. |
Mandate Benefits shall
be subject to the same deductibles, durational limits, and coinsurance
factors as are benefits for physical illness generally. Use of out-of-network providers: 20%
coinsurance. Precertification required
beyond 26 OP visits. |
State employees
only |
n/a |
|
|
ND Cent. Code §26.1-36-09
(p.15) §26.1-36-08 (substance
abuse, p. 13) (1995, 2003) |
2003: SB
2210 (substance abuse) |
Coverage
Defined by Plan Mental disorders
and substance abuse |
Mandate Minimum: 45 IP
days, 120 days of partial hospitalization, 120 days of residential treatment,
30 OP hours. Regarding partial
hospitalization and residential treatment: charges must be reasonably similar
to the charges for care
provided by hospitals Regarding OP
treatment: no deductible or co-payment for the first 5 hours, no co-payment
greater than 20% for the remaining hours.
Out-of-network: co-pays may be greater than 20% after the first 5
visits. |
Group and HMO |
Businesses with
50 of fewer employees may have basic health insurance coverage that does not
include substance abuse |
|
|
OH Rev. Code §§ 3923.281 3923.282 3923.30 (1985,2006) See SB 116
(2006) (Online statutes not up-to-date) |
2006: SB 116 |
Coverage Defined by Plan Mental or
emotional disorders Limited
Coverage Biologically
based mental illness: schizophrenia, schizoaffective disorder, bipolar
disorder, paranoia and other psychotic disorders, obsessive-compulsive
disorder, and panic disorder |
Mandated
if Offered OP services
equal to at least $550/year. Subject
to reasonable deductibles and coinsurance Mandate (biologically based) Coverage under
the same terms and conditions as, and shall provide benefits no less
extensive than, those provided under the policy of sickness and accident
insurance for the treatment and diagnosis of all other physical diseases and
disorders |
Group |
Regarding
biologically-based mental illness: Incurred claims for biologically based
mental illness caused a 1% or more increase in the cost for claims and
administrative expenses, and that increase could justifiably cause a 1% or
more increase in premiums |
|
|
OK Stat. Title
36 §§6060.10 (1999) |
1999: SB 2 |
Limited
Coverage Severe mental
illness: schizophrenia, bipolar disorder, major depressive disorder, panic
disorder, obsessive-compulsive disorder, and schizoaffective disorder. |
Mandate Benefits shall
be equal to benefits for treatment of and shall be subject to the same
preauthorization and utilization review mechanisms and other terms and
conditions as all other physical diseases and disorders (Including
medication, IP, OP, co-pays, coinsurance and deductibles) |
Group |
Businesses with
50 or fewer employees, or 2% increase in base premium costs |
|
|
(2000, 2005) |
2005: SB
1 2005: SB
913 |
Coverage
Defined by Plan Mental or
nervous conditions and chemical dependency, including alcoholism |
Mandate Benefits must be
at the same level as, and subject to limitations no more restrictive than,
those imposed on coverage or reimbursement of expenses arising from treatment
for other medical conditions.
Deductibles and coinsurance for treatment in health care facilities or
residential programs or facilities may not be greater than those for expenses
of hospitalization in the treatment of other medical conditions. Deductibles
and coinsurance for outpatient treatment may not be greater than for expenses
of outpatient treatment of other medical conditions. |
Group and HMO |
n/a |
|
|
(1998) |
1998: HB
366 |
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. |
Mandate 30 IP days, 60
OP days Annual lifetime
and dollar limits must be equal to those for other illnesses. Cost-sharing arrangements must not prohibit
access to care |
Group and HMO |
Businesses with
50 or fewer employees |
|
|
(1995, 2002) |
2001: HB 5478 2001: SB 832 |
Broad
Coverage Mental
illnesses: any mental disorder and substance abuse disorder that is listed in
the most recent revised publication or the most updated volume of either the
DSM or the International Classification of Disease Manual and that
substantially limits the life activities of the person with the illness;
provided, that tobacco and caffeine are excluded from the definition of
"substance" for the purposes of this chapter. "Mental
illness" shall not include: mental retardation, learning disorders,
motor skills disorders, communication disorders, and mental disorders
classified as "V" codes. |
Mandate Coverage must be
under the same terms and conditions as that coverage is provided for other
illnesses and diseases. Insurance coverage offered pursuant to this statute
must include the same durational limits, amount limits, deductibles, and
co-insurance factors for mental illness as for other illnesses and diseases. |
Group,
individual, and HMO |
n/a |
|
|
(1994) |
|
Full Coverage Psychiatric conditions: those mental and nervous conditions,
drug and substance addiction or abuse, alcoholism, or other conditions that
are defined, described, or classified as psychiatric disorders or conditions
in the most current publication of DSM. |
Mandated
Offering Benefits and
out-of-pocket payments may be different Minimum coverage
of $2,000 per year and $10,000 lifetime. |
Group |
n/a |
|
|
(2005) |
2005: SB
49 |
Limited
Coverage Mental health
conditions: bipolar disorder, major depressive disorder, obsessive compulsive
disorder, paranoid and other psychotic disorder, schizoaffective disorder,
schizophrenia, anxiety disorder, post-traumatic stress disorder, and
depression in childhood and adolescence |
Mandate A plan may not establish a rate, term, or condition that places
a greater financial burden on an insured for access to treatment for a mental
health condition than for access to treatment for a physical health
condition. Any deductible or
out-of-pocket limits required under a health insurance plan must be
comprehensive for coverage of both mental health and physical health
conditions. However, the section does
not require a health insurance plan to provide rates, terms, or conditions
for access to treatment for mental illness that are identical to rates,
terms, or conditions for access to treatment for a physical condition. |
Group,
individual, and HMO |
n/a |
|
|
SC Code §1-11-760 (2000) Reenacted by SC Code §1-11-780 (2005) (State Employees
Only) |
2000: SB 1041 |
Limited
Coverage Mental health conditions:
schizophrenia, schizoaffective disorder, major depressive disorder, bipolar
disorder, pervasive developmental disorder or autism, panic disorder,
obsessive-compulsive disorder, social anxiety disorder, anorexia, bulimia,
Asperger's disorder, intermittent explosive disorder, post-traumatic stress
disorder, psychosis not otherwise specified when diagnosed in a child under
seventeen years of age, Rett's disorder, or Tourette's disorder. Includes substance abuse. |
Mandate A plan shall not
establish any term or condition that places a greater financial burden on an
insured for access to treatment for a mental health condition or alcohol or
substance abuse than for access to treatment for a physical health condition.
Any deductible or out-of-pocket limits required under the state health
insurance plan must be comprehensive for coverage of mental health
conditions, alcohol or substance abuse, and physical health conditions |
State employees
only |
Cost increase of
1% at the end of three years, or a 3.39% increase at any time. |
|
|
(1998) |
1998: HB 1262 |
Limited
Coverage Biologically
based mental illness: Schizophrenia and other psychotic disorders, bipolar
disorder, major depression, and obsessive-compulsive disorder. |
Mandate The same dollar
limits, deductibles, coinsurance factors, and restrictions as for other
covered illnesses. |
Group,
individual, and HMO |
n/a |
|
|
(1998) |
1998: HB
3177 |
Coverage
Defined by Plan Mental illness,
substance abuse not included |
Mandate Aggregate
lifetime and annual limits must be the same as those for
medical/surgical. A minimum of 20 IP
days and 25 OP visits must be covered.
Limits for MH cost-sharing cannot be greater than those for
medical/surgical. Coinsurance,
co-payments, deductibles, or differentials may be different. |
Group |
Businesses with
25 or fewer employees, or a cost increase of more than 1% |
|
|
(1974, 1998) |
|
Coverage
Defined by Plan Psychiatric disorders,
mental or nervous conditions, alcoholism, drug dependence, or the medical
complication of mental illness or mental retardation. |
Mandated
Offering Aggregate
lifetime and annual limits (for mental health benefits, not substance abuse)
must be the same as those for medical/surgical |
Group and
individual |
Businesses with
50 or fewer employees or a cost increase of at least 1% |
|
|
(1997, 2003) |
1997: HB
1173 2003: SB
541 |
Limited
Coverage Serious mental
illness: bipolar disorders, depression in childhood and adolescence, major
depressive disorders, obsessive-compulsive disorders, paranoid and other
psychotic disorders, pervasive developmental disorders, schizo-affective
disorders, and schizophrenia. |
Mandate 45 IP days, 60 OP visits. May not include a lifetime limit and must include the same amount limitations, deductibles,
co-payments, and coinsurance factors for serious mental illness as the plan
includes for physical illness. (Mandated Offering
to small employers) |
Group and HMO |
Businesses with
50 or fewer employees |
|
|
(2000) |
2000: HB 35 |
Broad
Coverage Mental health
condition: any condition or disorder involving mental
illness that falls under any of the diagnostic categories listed in the
DSM. Does not include the following
when diagnosed as the primary or substantial reason or need for treatment:
marital or family problem; social, occupational, religious, or other social
maladjustment; conduct disorder; chronic adjustment disorder; psychosexual
disorder; chronic organic brain syndrome; personality disorder; specific
developmental disorder or learning disability; or mental retardation. |
Mandated
Offering Insurers must
offer a choice between catastrophic mental health coverage and 50/50 mental
health coverage. A “catastrophic”
policy does not impose any lifetime limit,
annual payment limit, episodic limit, inpatient or outpatient service limit,
or maximum out-of-pocket limit that places a greater financial burden on an
insured for the evaluation and treatment of a mental health condition than
for the evaluation and treatment of a physical health condition. However it may include a restriction on
cost sharing factors, such as deductibles, co-payments, or coinsurance, prior
to reaching any maximum out-of-pocket limit.
A “50/50” policy pays for at least 50% of covered services for the
diagnosis and treatment of mental health conditions and may include a
restriction on episodic limits, inpatient or outpatient service limits, or
maximum out-of-pocket limits. |
Group and HMO |
n/a |
|
|
(1997) |
1997: HB 57 |
Full
Coverage Mental health
condition: any condition or disorder involving mental illness or alcohol or
substance abuse that falls under any of the diagnostic categories listed in
the mental disorders section of the ICD, as periodically revised. Includes substance abuse. |
Mandate Plans must not
establish any rate, term, or condition that places a greater financial burden
on an insured for access to treatment for a mental health condition than for
access to treatment for a physical health condition. Plans must make deductible or out-of-pocket
limits required under a health insurance plan comprehensive for coverage of
both mental health and physical health conditions. |
Group and
individual |
n/a |
|
|
(1999) |
1999: SB 430 |
Limited
Coverage Biologically
based mental illness: schizophrenia, schizoaffective disorder, bipolar
disorder, major depressive disorder, panic disorder, obsessive-compulsive
disorder, attention deficit hyperactivity disorder, autism, and drug and
alcoholism addiction. |
Mandate Coverage shall
neither be different nor separate from coverage for any other illness,
condition or disorder for purposes of determining deductibles, benefit year
or lifetime durational limits, benefit year or lifetime dollar limits,
lifetime episodes or treatment limits, co-payment and coinsurance factors,
and benefit year maximum for deductibles and co-payment and coinsurance
factors. |
Group,
individual, and HMO |
Businesses with
25 or fewer employees |
|
|
(2004) |
|
Coverage
Defined by Plan Mental,
emotional, or nervous disorders.
Substance abuse included |
Mandate Minimum 20 IP
days for adults and 25 IP days for children, and 20 OP visits for adults and
children. Coverage shall be no more
restrictive than the limits of benefits applicable to physical illness;
however, the coinsurance factor applicable to any outpatient visit beyond the
first five of such visits covered in any policy or contract year shall be at
least fifty percent. |
Group and
individual |
n/a |
|
|
WA Rev. Code
§48.21.241 (G/HMO) §48.44.341
(Individual) (See HB 1460, online statutes not yet updated) (2005, 2007) |
2005: HB
1154 2007: HB
1460 |
Broad
Coverage Mental health
services: mental disorders covered by the DSM. Excludes: substance abuse; V Codes and
diagnostic codes 302-302.9 in DSM-IV; skilled nursing facility services, home
health care, residential treatment, and custodial care; and court ordered
treatment unless medically necessary. |
Mandate
Parity phased in
(compared to coverage for medical/surgical): coinsurance and co-payments in
2006, maximum out-of-pocket in 2008, and deductibles in 2010. |
Group,
individual, and HMO |
n/a |
|
|
(1987, 2005) |
|
Coverage
Defined by Plan Mental health
treatment |
Mandated
Offering Applies to
groups not covered by above |
Group |
n/a |
|
|
(1998, 2002) |
2002: HB
4039 |
Limited
Coverage Serious mental
illness: schizophrenia and other psychotic disorders, bipolar disorders,
depressive disorders, substance-related disorders with the exception of
caffeine-related disorders and nicotine-related disorders, anxiety disorders,
anorexia and bulimia. |
Mandate The insurer
shall not discriminate between medical-surgical benefits and mental health
benefits in the administration of its plan.
Aggregate lifetime and annual limits must be equal. |
Group and
individual |
Projected cost
increase of more than 2%, for groups with 25 or fewer members: a projected
cost increase of more than 1% |
|
|
(1998) |
|
Coverage
Defined by Plan Nervous and
mental disorders. Substance abuse
included. |
Mandate The lesser of 30
IP days or $7,000 ($6,300 if no cost sharing); $2,000 in OP services ($1,800
if no cost sharing); and $3,000 in transitional treatment arrangements
($2,700 if no cost sharing). |
Group |
n/a |
|
|
No
Parity Law |
|||||
* Full Coverage: All diagnoses in the DSM and/or ICD are covered
Broad Coverage: All diagnoses in the DSM
and/or ICD are covered, but with significant exceptions; or the state’s
language is broadly worded and does not
restrict coverage to certain groups
Limited Coverage: Coverage is restricted to
certain groups specified in the state’s language
Coverage Defined by Plan: The
populations to be covered are not specified in the state statute
† ICD: The International Classification of Diseases,
published by the World Health Organization, currently in its 10th
edition.
†† DSM: The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, currently in its fourth edition (DSM-IV-TR)