Michigan

There are two sections of the state insurance law relevant to parity. One is about substance use disorder coverage and the other is about autism coverage.

This section requires individual plans, small employer fully-insured plans, to cover substance use disorder services.

Plans must cover at least $1,500 per year for outpatient care and intermediate levels of care (this amount can be adjusted for inflation and has been since this law was written; currently it is over $4,000).

This section requires individual plans, small employer fully-insured plans, and large employer fully-insured plans to cover autism services through age 18.

It requires plans to cover an annual maximum of at least $50,000 through age 6, at least $40,000 from 7 through 12, and at least $30,000 from 13 through 18. Financial requirements for autism services must be the same as those in place for other medical services and there cannot be a limit on outpatient visits for autism treatment.

Plans may request that an autism diagnostic observation schedule (this term is defined in the law) be performed on a child once every three years, and plans may review a child’s treatment plan once a year.

Any individual plans or small employer fully-insured plan offered on the exchange under the Affordable Care Act does not have to cover anything in this section that goes beyond what is required of them from covering essential health benefits.

Autism spectrum disorders are defined as autistic disorder, Asperger’s syndrome, and pervasive developmental disorder not otherwise specified.

Treatment of autism spectrum disorder is listed as (all of these are defined in the law):

• Behavioral health treatment (applied behavior analysis)
• Pharmacy care
• Psychiatric care
• Psychological care
• Therapeutic care