District of Columbia Statutes

This law creates the Behavioral Health Parity Act of 2018 and requires all health benefit plans offered by an insurance carrier to meet the requirements of the Federal Part Act. It also requires all plans to submit an annual report to the Department of Health Care Finance on or before October 1 of every calendar year and requires the Department of Insurance, Securities, and Banking to enforce parity requirements. Additionally, the law prohibits insurers from imposing NQTLs on certain benefits for mental health conditions or substance use disorders unless enumerated requirements are met. Finally, the law requires Medicaid to provide coverage for medication-assisted treatment prescribed for the treatment of substance use disorders and to authorize the Mayor to issue rules to implement the provisions of the act.

Enacted through B 597

This law creates the Opioid Overdose Treatment and Prevention Omnibus Act of 2018. The law works to expand patient access to opioid use disorder treatment. The law requires the Department of Health Care Finance and the Department of Insurance, Securities, and Banking to undertake a study to determine the feasibility of expanding opioid use disorder medication offerings in the District. Furthermore, the law requires hospitals to develop protocols for identifying, treating, discharging and referring patients with opioid use disorder. Additionally, the law requires the Department of Corrections to ensure that individuals who receive treatment for opioid addiction prior to entering a Department of Corrections facility continue to receive that treatment.

Enacted through B 459

Under the Drug Abuse, Alcohol Abuse, and Mental Illness Insurance Coverage Act, individual and group health plans must provide coverage for medical and psychological treatment of drug abuse, alcohol abuse, and mental illness. Covered benefits for drug abuse, alcohol abuse, and mental illness in insurance policies is limited to inpatient, residential, and outpatient services certified as necessary by a physician, psychologist, advanced practice registered nurse, or social worker. The Act further provides for guidelines in determining reimbursement rates and states that charges for coverage of behavioral health services shall not be excessive and must be reasonably related to the cost of providing coverage based on a series of factors. The guidelines set out in the act are not applicable to the District of Columbia Alliance Program, Medicaid Program, and Post-1987 District of Columbia Employees’ Health Insurance Benefits Plan.
D.C. Code § 31-3105 mandates that methods for determining payment or reimbursement for mental health and substance abuse treatment services be consistent with those for physical illnesses in general. Methods for determining reimbursement rates shall take into consideration usual, customary, and reasonable charges for mental health services. Under D.C. code, deductibles and copayments can be applied. For individual and small group plans, inpatient and outpatient benefits set forth in D.C. Code § 31-3104 must have a lifetime payment limit of not less than $80,000 or one third of the lifetime maximum for physical illness. For large group plans, the inpatient and outpatient benefits set forth in D.C. Code § 31-3104 must be applied with the same lifetime limit and annual limits for medical, surgical and mental health benefits.
Group health plans can be exempt from complying with these mental health benefits provision if the cost of compliance for large group markets results in at least a 1% increase in the cost of the plan. Health maintenance organizations are held to the same mandatory coverage benefits as health insurers under the statute.

D.C. Code § 7-1131.19 established a behavioral health ombudsman to provide residents of D.C. with assistance in accessing behavioral health services. The ombudsman shall assist consumers in resolving problems concerning behavioral health providers, behavioral health facilities, and access to behavioral health care services and programs by referring consumers to appropriate regulatory agencies, guiding consumers through existing complaint processes, and assisting consumers in informally resolving problems through discussions with their providers. In addition, the ombudsman shall educate residents about behavioral health coverage, refer individuals to services, and create strategies and suggestions for improving access to quality mental health care.

D.C. Code § 31-3171.09 requires health benefit plans to comply with the Mental Health Parity and Addiction Equity Act of 2008 in order to be certified as qualified health plans. Health plans must cover behavioral health and outpatient services for mental health and substance use disorders without day or visit limitations. In addition, the D.C. Code states that for the purposes of the essential health benefits benchmark plan, health plans must include applied behavioral analysis for the treatment of autism spectrum disorder.

Enacted by 2012 D.C. Law 19-94, § 10, 59 DCR 213