 |
Home | Contact Us | Press Room | Site Overview | Help | Login | Register |
 |
 |
| About NCSL | State & Federal Issues | Legislatures | Legislative Staff | Meetings | Bookstore | Legislators & Staff Only |
| NCSL Home > State & Federal Issues: Issue Areas >Health > | Add to MyNCSL |
Health CareState Laws Mandating or Regulating Mental Health BenefitsUpdated: July 2007; reposted: December 1, 2007
Note that some laws apply primarily to "serious mental illness" and may not assure coverage for current circumstances. Many private market health plans include some type of mental health benefits on a voluntary commercial basis, not necessarily required by state or federal laws. Note that grief counseling may not be considered a covered benefit under some state laws, although it may be offered by insurers as part of a standard mental health benefit package. Laws in 21 states include coverage for substance abuse, alcohol or drug addiction. Most laws listed below were enacted prior to 2001. In 2002 laws were added in Alabama, Colorado, Kentucky, New Hampshire and New Jersey. In 2003, "barebones" laws allowing exceptions to mandated coverage, were enacted in Colorado, Montana and Texas. Maine expanded categories of illnesses covered; Hawaii and Kansas extended dates of existing coverage laws. In 2005, Washington enacted a full mental health parity law, applying to health insurance, but exempting policies for individuals and small group employers with 50 or fewer employees. It will take effect in phases between 2006 and 2010. Oregon also enacted a full parity law that took effect January 1, 2007. In 2006-07, three additional states passed full parity laws. New York's former Gov. George Pataki signed Timothy’s Law, named for a 12-year-old boy who committed suicide in 2001. The law requires that all private insurance policies have the same deductibles, number of office visits, number of inpatient visits and co-payments for mental health disorders as for other illnesses. The statute also requires that private plans provide at least 30 days of inpatient and 20 days of outpatient mental health care per year. In Ohio, outgoing Gov. Bob Taft signed his state’s first mental health parity law (SB 116) on Dec. 29, 2006. The Mental Health Parity Act mandates that coverage provided for seven “biologically based mental illnesses,” such as schizophrenia and bipolar disorder be on par with those for physical conditions. The state laws noted below generally do not apply to federally funded public programs such as Medicaid, Medicare, the Veterans Administration, etc. Also, "self-funded" health insurance plans, often sponsored by the largest employers, usually are entirely exempt from state regulation because of the federal ERISA law. Mental Health Parity Laws
State Eff. Date Insurance Policies Illnesses Covered. (1) Type of Benefit/ Co-pays and AL 2001: Individual and group with a small employer exemption of 50 or less. Mental illness. Mandated offering. Must be equal. AL 2002: Adds health care service plans and health maintenance organizations (signed 4/26/02) Mental illness Mandated offering Must be equal AZ Group with small employer exemption 50 or less, or cost increase of 1% or more. Mental illness. Mandate for plans that offer benefits. Can be different. AR Group: small employer exemption 50 or less; cost increase 1.5% or more. Mental illnesses and develop- Full parity. Must be equal. CA Group. Mental or nervous disorders. Mandated offering. Not specified. CA Group, individual and HMO. Severe mental illness. Full parity. Must be equal. CO Group. Mental illness excluding autism. Mandated benefits. Shall not exceed 50% of the payment. Deductible shall not differ. CO 1998: Group. Biologically Full parity. Must be equal. CO 2002: Provide coverage for substance abuse treatment regardless of whether the treatment is voluntary or court-ordered. (signed 5/28/02) Substance abuse clarification CO 2003: Allows exceptions for barebones policies exceptions CT Group Mental or nervous conditions; alcoholism and drug addiction. Full parity. Must be equal. DE 1999: Group and individual. Serious mental illnesses. Full parity. Must be equal. FL 1992: Group and HMO. Mental and nervous disorders. Mandated offering. May be different after minimum benefits are met. GA 1998: Mental disorders including substance abuse. Mandated offering. Must be equal. HI Group and individual with small employer exemption- Serious mental illness. Full parity. Must be HI Individual, group and HMO. Mental illness. Mandated benefits. Must be comparable. HI 2003: Makes law permanent, deleting sunset dates. Mental illness. Full parity IL Group. Mental, emotional or Full parity 2005 Mandated offering, 1991-2004 Insured may be required to pay up to 50% of the expenses incurred. IN 2000: Group, individual and state employees with a small employer exemption 50 or less, or cost increase of 4% or more. Mental illness. Mandate for plans that offer benefits. Must be IN 2003: Adds substance abuse benefit for those with mental illnesses Substance abuse Mandate for those with mental illnesses KS 1998: Group, individual, HMO and state employee plans. H. 2071 extended sunset to Dec. 31, 2003. Alcoholism or drug abuse or mental conditions. Mandated benefits. Not KY 1986: Group. Mental illness. Mandated offering. To the same extent as coverage for physical illness. KY 2000: Group with small employer exemption of 50 or less. Mental illness and alcohol and other drug abuse. Mandate for plans that offer benefits. Equal if offered. KY 2002: Small employer exemption raised to 51. LA Group, HMO and state employee benefit plans. Serious mental illness. Mandated benefits. Must be equal. LA 1982: Group, self-insured and state employee plans. Mental illness. Mandated offering. Must be equal. LA 1982: Group. Alcoholism and drug abuse. Mandated offering. Not specified. ME Group with a small employer exemption for 20 or less. Mental illness. Full parity. Must be equal. ME Individual plans must offer coverage. Mental illness. Mandated offering. Must be equal. ME 2003: Group of 21 or more, including HMOs, adds substance abuse-related disorders and other illness categories. Substance abuse, etc. Full parity MD Individual and group. Mental illness, emotional disorder, drug abuse or alcohol abuse disorder. Full parity Must be equal. except otpt. 80% -visits 1-5; 65% - visits 6-30; MD 2002: Requires individual and group insurers, nonprofit health service plans, and HMOs to provide coverage for medically necessary residential crisis services. Residential crisis services MA Individual, group and HMO. Mental or nervous conditions. Mandated benefits. Not specified. MA Individual, group and HMO. Biologically-based mental illness. Full Parity for bio-based; mandated benefits of mental illness and substance abuse. Must be equal. MI 2001: HMO's only, group and individual contracts, with a cost exemption of 3%. Mental health and substance abuse Minimum mandated benefits. Charges, conditions for services shall not be less favorable than the maximum for any other comparable service. MN 1995; 2000: Group, individual and HMO's (full parity for HMO's). Mental health and chemical dependency. Full parity for plans that offer coverage and HMO's. Must be equal. MS Group. Alcoholism. Mandated benefit. Not specified. MS 2002: Group and individual with a cost exemption of 1%. Mental illness. Mandated offering for small employers of 100 or less. Minimum mandated benefits for others. Must be equal for inpatient and partial, however, payment for outpatient visits shall be a minimum of fifty percent (50%) of covered expenses. MO 1997: Group, individual and HMO. Mental disorders and chemical dependency. Mandated offering. Must be equal. MO 2000: Group and individual. Mental illness including alcohol and drug abuse. Mandate for plans that offer benefits. Shall not be unreason- MT Group and individual. Severe mental illness. Full parity. Must be equal. MT 1997; 2001 Group. Mental illness alcoholism and drug addiction. Mandated benefits. No less favorable up to maximums. MT 2003: 12 month pilot allows exceptions for barebones policies. Exceptions NE 2000: Group and HMO with a small employer exemption of 15 or less. Serious mental illness. Mandate for plans that offer coverage. May be different. NV 2000: Group and individual with a small employer exemption 25 or less, or cost increases of 2% or more. Severe mental illness. Mandated benefits. Not more than 150% of out-of- NH Group, individual and HMO. Specifies different benefits for mental illness under major medical and non-major medical plans. Mental or nervous conditions. Mandated benefits. Ratio of benefits shall be substantially the same as benefits for other illnesses. NH 1995: Group. Biologically- based mental illnesses Full parity. Must be equal. NH 2002: Any policy of group or blanket accident or health insurance. Parity for bio- based illnesses, mandated benefits for other MI's and substance abuse NJ 1999: Group and individual Biologically- based mental illnesses Full parity. Must be equal. NM Group with different exemptions for small and large employers. Mental health benefits. Full parity. Must be equal. NY 2006: -------------- All private insurance policies. -------------- mental health disorders ------------ Full parity --------- Must be equal. State to foot the bill for additional costs incurred by businesses with fewer than 50 employees; the Legislature allocated some $50 million to cover those costs NC State employee plans only Mental illness and chemical dependency. Full parity. Must be equal. ND 1995: Group and HMO. Mental disorders, alcoholism and drug addiction. Mandated benefits. No deductible or copay for first 5 hours not to exceed 20% for remaining hours. ND 2003: Adds that inpatient treatment and partial hospitalization, or alternative treatment must be provided by an addiction treatment program licensed under chapter 50-31. Substance abuse Clarification OH 2006: ---------- Law signed 12/29/06; effective --------------- 7 “biologically based mental illnesses,” such as schizophrenia and bipolar disorder Full Parity ----------- ------------- OK 2000: Group with a small employer exemption 50 or less, or cost increase of 2% or more. Severe mental illness. Full parity. Must be equal. OR 2005: Group and HMO. Group. Mental or nervous conditions including alcoholism and chemical dependency. Mandated benefits. Shall be no greater than those for other illnesses. PA Group and HMO-small employer exemption 50 or less. Serious mental illness. Mandated benefits. Must not prohibit access to care. RI Individual, Serious mental illness. Full parity. Must be equal. RI 1/1/2002 Expands the state mental health parity law to include coverage for all mental illnesses and substance abuse disorders. All mental illnesses & substance abuse disorders. Full parity Must be equal SC Group. Psychiatric conditions, including substance abuse. Mandated offering. May be different. SC 1/1/2002 State employee insurance plan with cost increase exemptions. Mental health condition or alcohol or substance abuse. Full parity. Must be equal. SD 1998 Group, individual and HMO. Biologically- based mental illness. Full parity. Must be equal. TN 2000 Group with a small employer exemption 25 or less, or cost increase of 1% or more. Mental or nervous conditions. Mandated benefits. Must be equal. TX 1991 State employee plans. Biologically-based mental illness. Full parity. Must be equal. TX Group and HMO, with a small employer exemption of 50 or less. Serious mental illness. Mandated benefits Must be equal. TX 2003: Allows insurers and HMOs to offer policies without mandates for the treatment of mental illness and chemical dependency, with an exception for serious mental illnesses. Exceptions UT Group (as of 7/1/01) and HMO's (as of 1/1/01) Mental illness as defined by the DSM. Mandated offering. May include a restriction. VT Group and individual. Mental health condition including alcohol and substance abuse. Full parity. Must be equal. VA 2000 thru Group and individual with a small group exemption 25 or less. Biologically-based mental illness including drug and alcohol addiction. Full parity. Must be equal to achieve the same outcome as treatment for any other illness. VA Effective 7/1/2004. Group, individual and HMO. Mental health and substance abuse. Mandated benefits. Co-insurance for otpt. can be no more than 50% after 5th visit. All others must be equal. VA Repeals sunset date of 7/1/04, above. Mental health and substance abuse. VA S 212 of '04 Establishes Inspector General for Mental Health Mental health WA Group and HMO. Mental health treatment. Mandated offering. Reasonable deductible amounts and co-payments. 2005 WV 1998 Group and individual with a cost increase exemption of 1%. Mental or nervous conditions. Mandated offering. Not specified. WV 2002 Mental illness & substance abuse Full parity WI Group (with "at least specified minimum benefits in every group contract") Mental or nervous disorders Mandated offering Comparable deductibles and copays
B) Examples of "Barebones" exception laws:
Federal Parity Amendment On October 30, 2001 the U.S. Senate passed a broader parity bill, which was sent to the House. On December 18, in a House-Senate negotiating meeting, the House members rejected the Senate bill by a 10n-7y vote. The New York Times reported that sponsors Senators Domenici and Wellstone "said they wanted to requires health plans and insurance companies to provide equivalent coverage, or parity for mental and physical illness. House Republicans, employers and insurance companies objected to the proposal, saying it would increase costs for employers in a recession, when many businesses are already cutting health benefits because of a resurgence in medical inflation."6 9-11: Terrorism Impacts on Mental Health The events of September 11, 2001 and related bio-terrorism scares had a profound effect on Americans in every part of the United States. In 2003, the war with Iraq brought the potential for new psychological and mental health concerns, according to the American Psychological Association. Yet the issues raised have been a part of health policy for more than two decades. The nation, through the actions of federal, state and local governments, and citizens in innumerable roles, united and moved forward. However, the medical traumatic effects of those events impacted many people, for months or even years. USA Today reported it this way: "The terrorist strikes and their devastating aftermath are triggering the largest mental health challenge ever faced by employers and straining the USA's army of grief counselors, not just at the attack sites but in workplaces across the country. The emotional fallout was expected to be so widespread that some health insurers are loosening restrictions on employees' use of mental health services." [1] The impact could be far larger than the numbers directly affected. For example, just in Arlington County, Virginia, "some 20,000 to 40,000 of the county's 200,000 residents could experience a traumatic stress reaction from the attacks, officials estimate, pointing to an earlier Surgeon General's report on mental health and disasters." [2] Mental Health Benefits and Hurricane Katrina Victims The widespread harm inflicted by Hurricane Katrina includes health impacts and longer-term mental and emotional harm. People who are displaced, injured, have lost loved ones, homes, property, belongings, jobs, family stability, pets, and those with friends, relatives or coworkers affected, may need or seek counseling and medical help. Some, but not all, of the varying state health insurance mandate laws may require coverage of either emergency or longer-term mental health services. The list below is a general survey of these laws. It provides a quick comparison among states, but it is not intended as a consumer guide to services, since coverage varies even further based on employer and individual contracts, including services offered above or beyond the minimum required by state law. Also public programs including Medicaid, Medicare, local health departments have separate standards of coverage - sometimes more extensive -- than private market health policies. Expert Sources and Reports 1. U.S. General Accounting Office, "Mental Health Parity Act: Despite Federal Standards, Mental Health Benefits Remain Limited" GAO/HEHS-00-95 (Washington, D.C., May 2000) [includes state charts]
For related news stories and resources see:
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© 2008 National Conference of State Legislatures, All Rights Reserved
Denver Office: Tel: 303-364-7700 | Fax: 303-364-7800 | 7700 East First Place | Denver, CO 80230 | Map
Washington Office: Tel: 202-624-5400 | Fax: 202-737-1069 | 444 North Capitol Street, N.W., Suite 515 | Washington, D.C. 20001
