Below is the national Mental Health America Policy Position and Call to action regarding mental health parity in health insurance.1 This position paper sets the context for policy work on parity.
The key issues are: The Metal Health America Policy Position and Call to Action was adopted in September 2006, before the passage of the Mental Health Parity and Addiction Equity Act in 2008.
Requires a health benefit plan to provide coverage for the screening, diagnosis and treatment of autism spectrum disorder for individuals age nine or under in policies and contracts to employers with at least 51 employees for at least 50 percent of its working days for the preceding calendar year. 74 ) Requires policies issued by certain health insurers to provide coverage for the diagnosis and treatment of autism spectrum disorder. Treatment includes: (i) Applied behavior analysis when provided by or supervised by a Board Certified Behavior Analyst; (ii) Pharmacy care; (iii) Psychiatric care; (iv) Psychological care; (v) Therapeutic care (which includes services provided by licensed speech therapists, occupational therapists, or physical therapists); and (vi) Equipment determined necessary to provide evidence-based treatment; provided such treatments determined by a licensed physician to be medically necessary and evidence-based. Treatments include: professional services and treatment programs, including applied behavior analysis and evidence-based behavior intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorder or autism and includes speech-language pathology and audiology.
Coverage is limited to treatment that is prescribed by the insured's licensed physician or licensed psychologist and includes: behavioral health treatment, pharmacy care, psychiatric care, psychological care, and therapeutic care (which includes services provided by a licensed and certified speech therapist). Code §10A-20-6.16 and 27-21A-23 [PDF] (as created by S. 283 ) Requires certain insurers to provide coverage for the diagnosis and treatment of autism spectrum disorder for individuals under 21 effective January 1, 2013. Treatment includes: diagnosis, assessment and services. Note: Speech language services are not clearly defined in the statue.
Coverage under this section shall not be denied on the basis that the treatment is habilitative or nonrestorative in nature. Coverage for benefits for any covered person diagnosed with one or more autism spectrum disorders and whose age is at least seven years and less than 19 years shall not exceed $27,000 per year. Coverage for autism spectrum disorders shall be subject to $1,000 maximum benefit per month, per covered individual. Coverage shall be subject to a maximum benefit of $36,000 per year and a lifetime maximum benefit of $144,000.
Treatment includes: behavioral health treatment; pharmacy care; psychiatric care; psychological care; therapeutic care (including services provided by a speech, occupational, or physical therapists or an aide or assistant under their supervision); items and equipment necessary to provide, receive, or advance in the above listed services, including those necessary for applied behavioral analysis; and any care for individuals with autism spectrum disorders that is determined by the Secretary of the Department of Health and Social Services, based upon their review of best practices and/or evidence-based research, to be medically necessary. Coverage for benefits for any covered person diagnosed with one or more autism spectrum disorders and whose age is between birth and less than seven years shall not exceed $36,000 per year. All health benefit plans in the individual and small group market shall provide coverage for pharmacy care, if covered by the plan: psychiatric care; psychological care; therapeutic care (includes services provided by licensed speech therapists, occupational therapists, or physical therapists); applied behavior analysis; habilitative and rehabilitative care. Treatment includes: habilitative or rehabilitative care; pharmacy care; psychiatric care; psychological care; therapeutic care (including services provided by licensed or certified speech therapists, occupational therapists, or physical therapists licensed or certified in this state), provided the care prescribed, provided, or ordered for an individual diagnosed with one of the autism spectrum disorders by a physician or psychologist who shall be licensed in this state and who shall supervise provision of such care. Treatment includes: habilitative or rehabilitative services, including applied behavior analysis or other professional or counseling services; counseling services provided by a licensed psychiatrist, psychologist, clinical professional counselor or clinical social worker; and therapy services provided by a licensed or certified speech therapist, occupational therapist or physical therapist.
Covered treatment includes medically necessary pharmacy care, psychiatric care, psychological care, habilitative or rehabilitative care, and therapeutic care (which includes services provided by a licensed speech-language pathologist.) There is no limit on the number of visits an individual may make to an autism services provider. However, behavioral therapy is specifically defined as applied behavioral analysis and coverage limitations for behavioral therapy are set out.
§20-826.04; §20-1057.11; §20-1402.03; §20-1404.03 Requires health benefit plans issues or renewed on or after October 1, 2011 to provide for coverage for the diagnosis and treatment of autism spectrum disorder. §23-99-418 [PDF] (as created by HB 1315 ) Requires all health care service plan contract that provides hospital, medical, or surgical coverage to provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012. Treatments include: evaluation and assessment services; Behavior training and behavior management and applied behavior analysis; habilitative or rehabilitative care, including, but not limited to, occupational therapy, physical therapy, or speech therapy, or any combination of those therapies; pharmacy care and medication; psychiatric care; psychological care; and therapeutic care, including, but is not limited to, speech, occupational, and applied behavior analytic and physical therapies. However, behavioral therapy is specifically defined as applied behavioral analysis and coverage limitations for behavioral therapy are set out. We suggest upgrading your browser to the latest version of your favorite Internet browser.A: The best place to find out whether you have coverage for mental health conditions, or drug or alcohol use disorders is to read your certificate of coverage (referred to as a “summary,” “summary plan description,” or a “cert book”).You may receive a hard copy or be able to access this document online.As you review the summary, you will find a section describing any benefits under your plan for mental health conditions and/or drug or alcohol use disorders.The health law contains provisions aimed at curbing this piecemeal approach to coverage.