Promising Practices: Legislation

Pennsylvania

Among many other things, HB 2173 from the current legislative session will do the follwoing:

Click here and look at the first entry under “Introduced Legislation” to learn more about this bill.

View the Pennsylvania Report

Promising Practices: Litigation

New York

In 2014 and 2015 the New York Attorney General’s Office reached settlements with 5 major insurance companies after investigating these insurers and their plans for possible parity violations. The investigations began after the office’s Health Care Bureau received numerous complaints regarding behavioral health coverage denials.

View the New York Report

Promising Practices: Regulation

New York

The New York Department of Financial Services, which is responsible for regulating health insurance, issued a letter (pdf | Get Adobe® Reader®) to health insurers in December of 2014. This letter made clear that insurance plans cannot deny to cover medically necessary services for gender dysphoria (pdf | Get Adobe® Reader®). The letter explained that state law and the Federal Parity Law require insurance plans to cover services for gender dysphoria.

View the New York Report

Promising Practices: Legislation

New York

A10164/S07912 from 2014 requires plans to use peer-reviewed clinical review criteria when making medical necessity review decisions for people with substance use disorders. In addition, medical necessity decisions for substance use disorder treatment must now be made by professionals who specialize in substance use disorder treatment. The law also allows people with substance use disorders to use an expedited appeals process and not be denied care during the appeals process. The law also requires all substance use disorder coverage to comply with the Federal Parity Law.

View the New York Report

Promising Practices: Legislation

North Dakota

SB 2046 from 2015 changed the state public welfare law so that the state Medicaid program will now cover some behavioral health services provided by licensed marriage and family therapists.

View the North Dakota Report

Promising Practices: Legislation

Alaska

Among many other things, HB 292 from 2014 changed the state insurance law so that plans now have to “comply with the mental health or substance use disorder benefit requirements established” by the Federal Parity Law.

View the Alaska Report

Promising Practices: Regulation

South Dakota

The South Dakota Division of Insurance issued extensive regulations specifically about parity. These regulations are found in the state administrative code in Chapter 20:06:58. The regulations span from 20:06:58:01 through 20:06:58:45. These regulations are worded very similarly to the final regulation (pdf | Get Adobe® Reader®) for commercial plans for the Federal Parity Law. Pleas click here and scroll to “12/2014” to read a more detailed summary of these regulations.

View the South Dakota Report

Promising Practices: Legislation

Minnesota

HF779/SF662 from 2013 changed the state insurance law about behavioral health coverage, among many other things. Insurance plans have to meet the requirements of the Federal Parity Law and any regulations or other federal guidance issued regarding the Federal Parity Law.

View the Minnesota Report

Promising Practices: Legislation

North Carolina

HB 1183 from 2009 changed the sections of state law relevant to parity by requiring large employer fully-insured plans to comply with the Federal Parity Law, while SB 676 from 2015 required these plans to comply with any regulations issued about the Federal Parity Law.

View the North Carolina Report

Promising Practices: Legislation

Indiana

SB 102 from 2009 changed the state’s children’s services law so that the Children’s Health Insurance Program (CHIP) must cover the following behavioral health services:

View the Indiana Report

Promising Practices: Regulation

West Virginia

The West Virginia Insurance Commissioner updated the regulation regarding parity. Among other things it specified that plans must not “discriminate between medical-surgical benefits” and behavioral health benefits in terms of treatment limitations and financial requirements.

View the West Virginia Report

Promising Practices: Legislation

Utah

HB 24 from 2014 changed the parity section of the state insurance law to require individual plans and small employer fully-insured plans to cover behavioral health services and comply with the Federal Parity Law. HB 39 from 2010 required large employer fully-insured plans to comply with the Federal Parity Law, if they provided behavioral health coverage.

View the Utah Report

Promising Practices: Legislation

Nevada

SB 426 from 2009 added a section to the state insurance law that requires large employer fully-insured plans to comply with the Federal Parity Law and repealed the sections of the state insurance law about parity for large employer fully-insured plans, which were less favorable the the Federal Parity Law.

View the Nevada Report

Promising Practices: Legislation

Hawaii

Among other things, SB 2820/HB 2270 from 2014 requires plans to comply with the Federal Parity Law.

View the Hawaii Report

Promising Practices: Legislation

Maryland

Among other things, SB 556 from 2015 clarified that plans must provide at least 60 days of partial hospitalization for behavioral health services. It also specifies that all plans under this section of the law must comply with the final regulations for the Federal Parity Law .

View the Maryland Report

Promising Practices: Legislation

Maryland

HB 1252/SB 582 from 2013 requires that the criteria plans use in conducting utilization review for behavioral health benefits are in compliance with the Federal Parity Law .

View the Maryland Report

Promising Practices: Legislation

Wisconsin

AB 458 from 2014 changed state law so that Medicaid plans would cover behavioral health telehealth services, even if they are provided by an out-of-state provider, and in-home services without requiring fail-first protocol.

View the Wisconsin Report

Promising Practices: Legislation

Virginia

Among other things, HB 1747 from 2015 requires Virginia’s Bureau of Insurance to submit annual reports detailing denied claims, complaints, and appeals related to behavioral health coverage and the parity section of the insurance law. The Bureau must make these reports public and write them in “nontechnical, readily understandable language”

View the Virginia Report

Promising Practices: Regulation

Oregon

The Department of Consumer and Business Services (DCBS) issued a bulletin (pdf | Get Adobe® Reader®) to insurers in December 2012 about coverage for people with conditions related to gender identity (GI) or gender dysphoria (GD). The bulletin listed a number of requirements and clarified that certain coverage exclusions related to behavioral health care and medical care made on the basis that they were for procedures associated with GI, such as gender reassignment surgery, would be considered discriminatory. To learn about the specifics of this bulletin in greater detail, click here and scroll to “12/2012”.

View the Oregon Report

Promising Practices: Regulation

Oregon

The DCBS issued updated regulations in June of 2013 that apply to the parity section of the state insurance law. In addition to restating some of the requirements of the law, the regulations clarify several things, including a few things related to non-quantitative treatment limitations . To learn about the specifics of these regulations in greater detail, click here and scroll to “6/2013”.

View the Oregon Report

Promising Practices: Regulation

Oregon

The DCBS issued a bulletin (pdf | Get Adobe® Reader®) in November of 2014 that explained to plans what is required of them under the section of the state insurance law about autism coverage, in addition to how the Federal Parity Law and the Affordable Care Act (ACA) affect how plans must cover autism services, including applied behavior analysis (ABA). To learn about the specifics of this bulletin in greater detail, click here and scroll to “11/2014” (the second entry that is titled “11/2014”)

View the Oregon Report

Promising Practices: Regulation

Oregon

The Department of Consumer and Business Services (DCBS) issued a bulletin (pdf | Get Adobe® Reader®) in November of 2014 that explained to insurance plans what is required of them under the parity section of the state insurance law and the regulations that apply to it, what is required of them under the Federal Parity Law and its final regulation, and what is required of them relating to parity under the Affordable Care Act. To learn about the specifics of this bulletin in greater detail, click here and scroll to “11/2014” (the first entry that is titled “11/2014”)

View the Oregon Report

Promising Practices: Legislation

Oregon

HB 2103 from 2011 changed state law so that court-ordered services that are the result of a conviction for driving while intoxicated can be covered by Medicaid, if the services are medically necessary.

View the Oregon Report

Promising Practices: Legislation

Oregon

HB 2385 from 2013 changed the parity section of the state insurance law so that insurance plans are no longer exempt from covering court-ordered services that are the result of a conviction for driving while intoxicated.

View the Oregon Report

Promising Practices: Legislation

Rhode Island

Among many other things, H 6283/S 540 changed state law so that the Commissioner of Health Insurance is now required to monitor plans for compliance with the Federal Parity Law.

View the Rhode Island Report

Promising Practices: Legislation

Rhode Island

Among other things, H 8042/S 2801 from 2014 requires plans to cover prescription medications for substance use disorders, specifically mentioned are those used for opioid overdoses (like naloxone) and those used for chronic addiction (like methadone).

View the Rhode Island Report

Promising Practices: Legislation

Rhode Island

H 5837/S 490 from 2015 changed the section of the state insurance law about parity so that insurance plans must use the criteria of the American Society for Addiction Medicine when making coverage decisions for substance use disorder services.

View the Rhode Island Report

Promising Practices: Regulation

New Hampshire

In November of 2010, the New Hampshire Insurance Department issued regulations regarding compliance with the Federal Parity Law for large employer fully-insured plans (scroll to “Part INS 2702; relevant sections are from 2702.01 through 2702.09) These regulations clarified many things related to parity compliance. Please go to the New Hampshire regulatory page on our site to read a more detailed summary (scroll down to “10/2010”).

View the New Hampshire Report

Promising Practices: Regulation

Washington

In September of 2014, the Washington State Office of the Insurance Commissioner issued an updated regulation (pdf | Get Adobe® Reader®) regarding parity. The purpose of this regulation was to consolidate into one regulation all parity regulations regarding the Federal Parity Law and relevant sections of the state insurance law. This regulation clarified many issues related to parity compliance in precise detail. Please go to the Washington State regulatory page on our site to read a more detailed summary (scroll down to “9/2014”).

View the Washington Report

Promising Practices: Regulation

Washington

The Washington State Office of the Insurance Commissioner issued this letter (pdf | Get Adobe® Reader®) to insurance plans informing them that denying coverage for medically necessary services on the basis of gender identity or a diagnosis of gender dysphoria is against state and federal law. The Commissioner clarifies that the section of state law about discrimination explicitly supersedes any section of the state insurance law that might seem to allow these kinds of denials.

View the Washington Report

Promising Practices: Regulation

Washington

The Washington State Office of the Insurance Commissioner ordered plans (pdf | Get Adobe® Reader®) to identify any claims denied since 1/1/2006 that may have violated the state parity law, as it had been recently interpreted by the State Supreme Court, and inform those consumers that their claims can be reevaluated.

View the Washington Report

Promising Practices: Regulation

New Hampshire

The New Hampshire Insurance Department issued a bulletin (pdf | Get Adobe® Reader®) that clarified what is required of individual plans and small employer fully-insured plans subject to the Affordable Care Act (ACA) regarding autism coverage. It stated that the annual maximums in the section of the state insurance law about autism coverage cannot be considered limits on how much plans must cover because the ACA forbids annual dollar limits.

The bulletin clarifies that because one of the parity sections of the state insurance law lists autism as a “biologically-based mental illness”, autism coverage is an essential health benefit and plans must comply with the Federal Parity Law for autism services

View the New Hampshire Report

Promising Practices: Legislation

New Hampshire

SB 564 from the 2015-2016 legislative session changed state law so that Medicaid managed care organizations cannot require prior authorization for medications for treatment of individuals with schizophrenia, bipolar disorder, and major depression.

View the New Hampshire Report

Promising Practices: Regulation

Vermont

The Department of Financial Regulation issued a bulletin notifying plans that they may “not exclude coverage for medically necessary treatment including gender reassignment surgery for gender dysphoria and related health condition” It then stated that “new insurance policy forms filed by insurers will be disapproved by DFR if they exclude such coverage”

View the Vermont Report

Promising Practices: Regulation

Vermont

The Department of Financial Regulation issued a regulation about distinguishing behavioral health primary care services from behavioral health specialty services, as required by the state law. Primary care services were defined as follows:

  • The most common or routine behavioral health services
  • Outpatient services only
  • Services provided to all regardless of age or gender

The regulation also noted that the Department would review these definitions every two years.

View the Vermont Report

Promising Practices: Regulation

Vermont

The Department of Financial Regulation fined Cigna Behavioral Health $392,500 for violations of the state insurance law, including sections relevant to parity. The fine resulted from the Department finding that Cigna had used the recommendations of “unlicensed review agents” in making coverage determinations. These agents were under contract with the plan’s independent review organization.

View the Vermont Report

Promising Practices: Legislation

Vermont

Among many other things, H 559 from the 2011-2012 session requires the Department of Financial Regulation to develop “performance quality indicators” to evaluate how plans and managed care organizations are complying with one of the parity sections of the state insurance law.

View the Vermont Report

Promising Practices: Legislation

Illinois

Among many other things, HB 1 (pdf | Get Adobe® Reader®) from the 2015-2016 Legislative Session requires Illinois Medicaid plans to cover any prescription medications for substance use disorders. It forbids prior authorization for these medications and states that any utilization review used has to follow American Society of Addiction Medicine criteria. It also requires Medicaid coverage for opioid antagonists.

View the Illinois Report

Promising Practices: Legislation

Illinois

Among many other things, HB 1 (pdf | Get Adobe® Reader®) from the 2015-2016 Legislative Session requires independent review organizations to use criteria from the American Society of Addiction Medicine when conducting external reviews.

View the Illinois Report

Promising Practices: Legislation

Illinois

Among many other things, HB 1 (pdf | Get Adobe® Reader®) from the 2015-2016 Legislative Session makes it clear that insurance plans must interpret non-quantitative treatment limitations as they are defined in the final regulations (pdf | Get Adobe® Reader®) for the Federal Parity Law.

View the Illinois Report

Promising Practices: Legislation

Illinois

Among many other things, HB 1 (pdf | Get Adobe® Reader®) from the 2015-2016 Legislative Session has specific language stating that insurance plans cannot use any criteria for substance use disorder treatment medical necessity reviews other than those put forth by the American Society of Addiction Medicine.

View the Illinois Report

Promising Practices: Regulation

Massachusetts

The Massachusetts Division of Insurance issued a regulation (pdf | Get Adobe® Reader®) about parity compliance. This regulation requires insurers to certify that they comply with the Federal Parity Law and the parity sections of state law. Plans must submit information about financial requirements, treatment limitations, medical necessity reviews, and anything else the Division thinks is relevant. The regulation also states that the Division can issue a $10,000 fine for each violation, revoke an insurer’s accreditation, and revoke or suspend an insurer’s license.

View the Massachusetts Report

Promising Practices: Legislation

Connecticut

Among many other things, SB 1160 from the 2013 General Assembly requires insurance plans to use criteria from the American Society of Addiction Medicine (ASAM) when performing utilization review for substance use disorder treatment. If a plan deviates from these criteria, it has to show peer-reviewed research that justifies the deviation from ASAM criteria. Click here (pdf | Get Adobe® Reader®) and go to the very last line of page 99 to read the relevant text.

View the Connecticut Report

Promising Practices: Regulation

Connecticut

The Connecticut Insurance Department Issued a bulletin (pdf | Get Adobe® Reader®) that requires insurance plans submit information that demonstrates their compliance with parity laws. The bulletin requires plans to fulfill 10 detailed requirements that address non-quantitative treatment limitations, financial requirements, reimbursement, classification of benefits, provide an analysis comparing criteria used for behavioral health services and criteria used for other medical services, and provide certification that they are compliant with the Federal Parity Law and the state parity law.

View the Connecticut Report

Promising Practices: Legislation

Missouri

The Missouri General Assembly passed a bill that was signed into law specifying how insurance plans should cover eating disorder treatment. Among other things, it states that all medically necessary care must be provided and specifies what qualifies as medically necessary care and in what settings (residential treatment, inpatient care, etc.) The bill also requires plans to follow the American Psychiatric Association’s Practice Guidelines for the Treatment of Patients with Eating Disorders when making medical necessity determinations.

View the Missouri Report

Promising Practices: Regulation

Missouri

The Missouri Department of Insurance, Financial Institutions and Professional Registration (DFIP) took action against Aetna for the company’s continued failure to comply with the section of state law that requires coverage for autism services. The DFIP and Aetna reached a $4.5 million settlement that also allows the DFIP to suspend Aetna from doing business in Missouri for one year if the insurer violates the settlement during a three-year monitoring period.

View the Missouri Report

Promising Practices: Legislation

Illinois

Among many other things, HB 1 from the 2015-2016 Legislative Session requires the Illinois Department of Insurance to proactively enforce the state parity law and the Federal Parity law. It also requires and funds the Department of Insurance to create a parity education program for consumers and providers.

View the Illinois Report

Promising Practices: Litigation

California

California’s Department of Insurance filed an amicus brief (pdf | Get Adobe® Reader®) in the state appellate court in support of the plaintiffs in the Rea v. Blue Shield of California case, which involved interpretation of California’s state parity law. This court overturned an earlier court ruling and found that plans cannot deny coverage for residential treatment of an eating disorder if it is considered medically necessary .

View the California Report

Promising Practices: Regulation

California

California’s Department of Managed Health Care (DMHC) issued guidance requiring all plans under its jurisdiction to submit reports showing their compliance with the Federal Parity Law . The DMHC provided insurers with detailed instructions (pdf | Get Adobe® Reader®), required them to complete worksheets (pdf | Get Adobe® Reader®) that compare their behavioral health coverage to other medical coverage, and required them to complete another worksheet (pdf | Get Adobe® Reader®) comparing their application of non-quantitative treatment limitations for behavioral health coverage and other medical coverage.

View the California Report

Promising Practices: Legislation

Massachusetts

Bill S 2400 from the 2011-2012 legislative session in Massachusetts, which was signed into law, included a provision that requires insurers to submit an annual report to the division of insurance and to the attorney general certifying and outlining how their plans comply with the Federal Parity Law and the Massachusetts state laws related to parity . The Attorney General can also request to have a public hearing on any of the reports.

View the Massachusetts Report