Louisiana

There are several sections of the state insurance law relevant to parity. They will be summarized below in this order (with appropriate hyperlinks to state law):

• Mental health coverage (two sections linked)
• Substance use disorder coverage
• Autism coverage

This section requires large employer fully-insured plans, small employer fully-insured plans, other group plans, and self-insured plans (except those exempted by ERISA ) to cover the following mental health conditions:

• Schizophrenia or schizoaffective disorder
• Bipolar disorder
• Panic disorder
• Obsessive-compulsive disorder
• Major depressive disorder
• Anorexia/bulimia
• Intermittent explosive disorder
• Posttraumatic stress disorder
• Psychosis not otherwise specified in children under seventeen years of age.
• Rett’s Disorder
• Tourette’s Disorder

This coverage must be “under the same circumstances and conditions or greater” as coverage for other medical conditions. Plans must cover at least:

• 45 days of inpatient care
• 52 visits of outpatient care, including intensive outpatient care

Enrollees can exchange each day of inpatient care for 4 outpatient visits or 2 days of residential treatment or partial hospitalization.

This section requires only large employer fully-insured plans to do the following regarding annual maximums and lifetime maximums:

Plans cannot use annual maximums and lifetime maximums for mental health services if they aren’t in place for other medical services. If a plan does have these in place for other medical services, they can do either of the following:

• Make it so that both behavioral health services and other medical services count towards combined maximums OR
• Make the maximums for mental health services no less than the ones in place for other medical services

For plans that have many different maximums for different categories of medical care, the law requires plans to use a mathematical formula involving the weighted averages these annual and lifetime maximums to decide what the limits and maximums should be for mental health services.

Plans are exempt from this section if complying with it causes premium costs to increase by 1% in any year.

This section requires large employer fully-insured plans and small employer fully-insured plans to offer optional coverage for substance use disorders that includes inpatient care, outpatient care, and residential treatment. However, this section does not specify anything further about how extensive this coverage should be.

This section requires large employer fully-insured plans and small employer fully-insured plans to cover autism services for individuals through age 20.

Plans must cover an annual maximum of $36,000.

Copayments, coinsurance, and deductibles must be “no less favorable” than those in place for other medical services.

There cannot be any visit limits for outpatient care.

There is no restriction on how often plans can review a child’s treatment plan.

Treatment for autism is defined as pharmacy care, psychiatric care, psychological care, therapeutic care, applied behavior analysis, habilitative care, and rehabilitative care.