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Mental Health Benefits State Mandates

State Laws Mandating or Regulating Mental Health Benefits

Updated: January 2014

Mental health services have been one significant part of medical care for a number of years. The costs, coverage and availability of such services have been the object of policy discussions and a variety of state legislation. There is not a uniform consensus about the extent to which state government should require coverage for mental health. Since the passage of federal health rorm (PPACA) there is a larger role for the federal government and federal-state coordination, described below.  For now, 49 states and D.C. currently have some type of enacted law but these laws vary considerably and can be divided roughly into three categories:

1.    Mental Health "Parity" or Equal Coverage Laws 
Parity, as it relates to mental health and substance abuse, prohibits insurers or health care service plans from discriminating between coverage offered for mental illness, serious mental illness, substance abuse, and other physical disorders and diseases. In short, parity requires insurers to provide the same level of benefits for mental illness, serious mental illness or substance abuse as for other physical disorders and diseases. These benefits include visit limits, deductibles, copayments, and lifetime and annual limits.
Parity laws contain many variables that affect the level of coverage required under the law. Some state parity laws--such as Arkansas'--provide broad coverage for all mental illnesses. Other state parity laws limit the coverage to a specific list of biologically based or serious mental illnesses. The state laws labeled full parity below provide equal benefits, to varying degrees, for the treatment of mental illness, serious mental illness and biologically based mental illness, and may include treatment for substance abuse. The newly enacted federal parity law affects insurance policies that already provide some mental health coverage; there is no federal law directly mandating parity to the same extent as state laws; also see background on unsuccessful federal parity legislation below the state table.

2.    Minimum Mandated Mental Health Benefit Laws 
Many state laws require that some level of coverage be provided for mental illness, serious mental illness, substance abuse or a combination thereof. They are not considered full parity because they allow discrepancies in the level of benefits provided between mental illnesses and physical illnesses. These discrepancies can be in the form of different visit limits, copayments, deductibles, and annual and lifetime limits. Some mental health advocates believe these laws offer a compromise to full parity that at least provides some level of care. Others feel that anything other than full parity is discrimination against the mentally ill. Some of these laws specify that copayments and deductibles must be equal to those for physical illness up to the required level of benefits provided. If a law does not specify, the copayment could be as much as 50 percent of the cost of the visit and require a separate deductible to be met before mental health visits will be covered.

3.    Mental Health "Mandated Offering Laws"
Mandated offering laws differ from the other two types of laws in that they do not require (or mandate) benefits be provided at   all. A mandated offering law can do two things. First, it can require that an option of coverage for mental illness, serious mental illness, substance abuse or a combination thereof, be provided to the insured. This option of coverage can be accepted or rejected and, if accepted, will usually require an additional or higher premium. Second, a mandated offering law can require that if benefits are offered then they must be equal.

*Exceptions to Mandate Laws – “Barebones” Policies

Note that some laws apply primarily to "serious mental illness" and may not assure coverage for particular individual diagnoses or 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 at least 38 states include coverage for substance abuse, alcohol or drug addiction.  

Beyond Coverage: What are State Roles?

There are numerous aspects of mental health and substance abuse that garner attention from state policymakers.  The following are links to NCSL reports and articles related to these subjects:
  • Mental Health Professionals' Duty to Warn -Doctors are responsible for maintaining confidentiality of patient information based on the ethical standards of their profession. However, In an effort to protect potential victims from a patient’s violent behavior many states have passed "duty to warn" laws. These laws impose a duty on psychotherapists to warn third parties of potential threats to their safety. Published by NCSL, January 2013.
  • The Impact of the Mental Health Party and Addiction Equity Act-- a 2013 report. Even After Parity Law, Consumers Spend More to Treat Substance Use In Hospitals   
    The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (“Parity Act”) increased access to mental health and substance use services in hospitals, yet consumers continued to pay more out-of-pocket for substance use admissions than for other types of hospital admissions, finds a new Health Care Cost Institute (HCCI) report.
    The report is one of the first of its kind to look at hospital spending, utilization, prices, and out-of-pocket payments for mental health and substance use admissions for those younger than age 65 with employer-sponsored health insurance.

Mental Health Benefits in the Affordable Care Act (PPACA) of 2010

Federal health reform, also termed the PPACA or just ACA, contains a number of provisions which achieve two goals with respect to mental health parity:
(1) they expand the reach and applicability of the federal mental health parity requirements; and
(2) they create an "essential health benefit" or mandated benefit for the coverage of mental health and substance abuse disorder services in a number of specific insurance financing arrangements. According to a December 2011 report by the Congressional Research Service (CRS), the ACA expands the reach of federal mental health parity requirements to three main types of health plans:
States Implement PPACA header
  • qualified health plans as established by the ACA;
  • Medicaid non-managed care benchmark and benchmark-equivalent plans; and
  • plans offered through the individual market.
  • The ACA did not alter the federal mental health parity requirements with respect to CHIP plans, but the application of the requirements to CHIP plans, as required in law prior to the ACA, is explained here in detail. This report also analyzes the impact of the ACA on the existing small employer exemption under federal mental health parity law.

Key Resources

 Federal CMS Guidance Regarding Mental Health Parity Requirements in CHIPRA, Medicaid and Group Insurance

The Federal Centers for Medicare & Medicaid Services (CMS) issued a State Health Official letter on November 4, 2009 regarding the mental health parity requirements under the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).  The letter provides general guidance on implementation of section 502 of CHIPRA, Public Law 111-3, which imposes mental health and substance use disorder parity requirements on all Children’s Health Insurance Program (CHIP) State plans under title XXI of the Social Security Act (the Act).  This letter also provides preliminary guidance to the extent that mental health and substance use disorder parity requirements apply to State Medicaid programs under title XIX of the Act.

In summary the letter addresses specific requirements in the measure as follows:

  1. Qualifying financial requirements and treatment limitations applied to mental health or substance use disorder benefits may be no more restrictive than those applied to medical surgical benefits.
  2. No separate qualifying criteria may be applied to mental health or substance use disorder benefits.
  3. When  out-of-network coverage is available for  medical surgical benefits, it must also be available for mental health or substance use disorder benefits.

Medicaid and Group Health Insurance:
Requirements from the Paul Wellstone and Pete Dominici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) became effective for group health insurance plans on October 3rd of 2009. These same requirements will only apply to Medicaid insofar as the state’s Medicaid agency contracts with one or more managed care organizations (MCOs) or Prepaid Inpatient Health Plans (PIHPs). In these cases the MCOs or PIHPs must be in compliance. A state Medicaid plan is not subject to these requirements otherwise. The MHPAEA applies to all CHIP programs and became effective April 1 of 2009. State CHIP plans are deemed in compliance if they provide coverage of Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) benefits.  

States Requiring Legislative Action for Compliance
The letter also specifies that if a state requires legislation in order to be in compliance with the requirements, a state will not be found to be in violation before its next legislative session as long as it notifies the Secretary of HHS and she concurs that legislation is needed. They ask that states in the circumstances submit a letter to the Center for Medicaid and State Operations to that effect as soon as possible and include information as follows: 

  1. the provisions in question,
  2. the reason the state requires legislative action for compliance, and
  3. the date the state will begin implementing the provision.

Federal Law Requiring Parity in Some Circumstances -

On October 3, 2008, the Emergency Economic Stabilization Act (HR 1424) passed Congress and was signed into law.  It included a major mental health provision - known as the "Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act," which was attached to the economic bill and also became law.  This federal mental health law requires health insurance plans that offer mental health coverage to provide the same financial and treatment coverage offered for other physical illnesses.  It does not mandate that group plans must provide mental health coverage.  [Parity Section 512 full text]

This legislation expands parity by requiring equality for deductibles, co-payments, out-of-pocket expenses, coinsurance, covered hospital days, and covered out-patient visits.  The measure also includes a small business exemption for companies with fewer than 50 employees, as well as a cost exemption for all businesses if it will result in a cost increase of 2% in the first year and 1% in each subsequent year.  The bill builds on the current 1996 federal parity law, which already requires parity coverage for annual and lifetime dollar limits.  The current HIPAA preemption standard applies.  This standard is extremely protective of state law.  Only a state law that "prevents the application" of this Act will be preempted, which means that stronger state parity and other consumer protection laws remain in place.   It will require the Comptroller General to inform Congress on health plans’ and health insurers’ coverage and exclusion rates, patterns, and trends of mental health and substance use disorder diagnoses.  The new law exempts businesses with 50 or fewer employees from its mental health parity requirements. 

Expanded Mental Health Coverage Rules - November 2013

In a move aimed at boosting mental health treatment, Health and Human Services Secretary Kathleen Sebelius on Nov. 8, 2013 announced new rules that will put teeth in a 2008 mental health equity law. The Mental Health Parity and Addiction Equity Act, signed by President George W. Bush, requires doctors and insurers to treat mental illness the same as physical illness. Sebelius made the announcement to applause at the Rosalynn Carter Symposium on Mental Health Policy in Atlanta. The move "finally puts mental health and behavioral health on equal footing," Sebelius said.

On paper, the law made mental health more accessible, but there has been virtually no enforcement of it, said Dr. Jeffrey Lieberman, president of the American Psychiatric Association and a Columbia University psychiatrist. "Up to now, the law has not been complied with," Lieberman said. "Companies have only sort of adhered to it." Insurance companies often cover mental illness in a more limited fashion than physical illness. Now the rule will require insurers to charge similar co-payments regardless if the treatment is for physical or mental health. Deductibles and doctor visits would also be equitable, and there would be parity in outpatient services and residential treatment.

 

"Many private insurers gave nothing. Some provided benefits, but they were limited and inadequate," Lieberman said. The law, the new rules and provisions of Obamacare combined will ensure mental and physical illness would be covered similarly. America's Health Insurance Plans (AHIP), the professional association that represents the health insurance industry, said it has long supported the act and has worked to implement its requirements in an affordable and effective way.  [Read article CNN 11/8/2013]

 

Federal Parity Amendment
In 1996 a federal parity amendment was signed into law as part of the VA-HUD appropriations bill. The law, otherwise known as the Mental Health Parity Act of 1996 (Public Law 104-204, see text online), prohibits group health plans that offer mental health benefits from imposing more restrictive annual or lifetime limits on spending for mental illness than are imposed on coverage of physical illnesses. This law expired on September 30, 2001 due to a "sunset" provision, but was extended through December 31, 2002 when President Bush signed Public Law 107-116.  The Mental Health Parity Act of 1996 offers limited parity for the treatment of mental health disorders.  The statute does not require insurers to offer mental health benefits, but states that if mental health coverage is offered, the benefits must be equal to the annual or lifetime limits offered for physical health care. It also does not apply to substance use disorders, and businesses with fewer than 26 employees are exempt..

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."

State Laws and Federal Limits: The state laws noted below generally do not apply to federally funded public programs such as Medicaid, Medicare, the Veterans Administration, etc.  In addition, "self-funded" health insurance plans, often sponsored by the largest employers, usually are entirely exempt from state regulation because they are preempted by the federal ERISA law. 

> See ERISA and the States, a 2008 online resource guide by NCSL.

 

 

Full Parity, Minimum Mandated Benefit and Mandated Offering State Laws

 

State

Title/Law Citation/Effective Date Insurance Policies Affected by law;
Exemptions
Illnesses Covered Type of Benefit Co-pays and Co-insurance
AL  Contract providing for mental health services to entitle insured to reimbursement for outpatient and inpatient services;
ST § 27-1-18;
Eff. 1975
Group Mental illness Mandated Offering Not Specified
Mental Illness coverage and health benefit plans;
ST § 27-54-1; ST § 27-54-2;
ST § 27-54-3; ST § 27-54-4;
ST § 27-54-5;
Eff. January 1, 2001
Group Mental Illness Mental Health Parity Must be equal
 AK Coverage for treatment of drug abuse or alcoholism;
ST § 21.42.365
Eff. July 1, 2004
Group, 5 employees or less exempt; 20 or less must offer coverage Alcoholism or drug abuse Minimum MandatedBenefit Not Specified
Mental health or substance use disorder benefits;
ST § 21.54.151;
Eff. Oct. 3, 2009
Group and Individual Mental Illness/ substance abuse Minimum MandatedBenefit Not Specified
AZ Mental health services and benefits; ST § 20-2322; Eff. Jan. 1, 1998 Group, 50 Employee exemption Mental Illness Mandated Offering Varies
 AR  Arkansas Mental Health Parity Act of 2009;
ST § 23-99-501 to 23-99-512;
Eff. On or after October 3, 2009 
Group,does not apply to any plan where application would result in a 1.5% increase in the cost of coverage Mental illness and substance use disorders Mental HealthParity Must be equal
Treatment of alcohol and drug dependency;
ST § 23-79-139;
Eff. After Nov. 17, 1987
Group and HMO Alcohol and other drug dependencies Mental HealthParity Must be equal
Minimum benefits for mental illness in group accident and health policies or subscriber's contracts;
ST § 23-86-113;
Eff. after July 1, 1983
Group Mental Illness Minimum Mandated Benefit Mental Illness copayments shall not exceed a twenty percent (20%) copayment requirement.
 CA Severe mental illnesses; serious emotional disturbances of children ;
INS § 10144.5; H & S § 1374.72;
Eff. January 1, 2000
Group, HMO and Individual Mental Illness Minimum Mandated Benefit Must be equal
Coverage for mental or nervous disorders;
INS § 10125;
Eff. January 1, 1974
Group Mental or nervous disorders Mandated Offering Not Specified
CO Substance abuse--court-ordered treatment coverage;
ST § 10-16-104.7;
Eff. Jan. 1, 2003
Group and Individual Substance Abuse Mandated Offering Subject to co-payment, deductible, and policy maximums and limitations
Mental health services coverage--court—ordered;
ST § 10-16-104.8;
Eff. March 31, 2006 
Group and Individual  Mental illness Mandated Offering Subject to in or out of network co-payment, deductible, and policy maximums and limitations
CT Mandatory coverage for the diagnosis and treatment of mental or nervous conditions;
ST § 38a-488a to 514;
Eff. January 1, 2000 
Group and Individual Mental or nervous conditions; alcoholism and drug addiction[i] Mental Health Parity Must be equal
DE Insurance coverage for serious mental illness;
ST TI 18 § 3578; ST TI 18 § 3343;
Eff. January 1, 1999 
Group and individual Serious mental illness Mental Health Parity Must be equal
 FL Optional coverage for mental and nervous disorders required; exception;
ST § 627.668;
Eff. July 4, 2000
Group and HMO Mental and Nervous Disorder Mandated Offering May be different after minimum premiums are met
Optional coverage required for substance abuse impaired persons; exception;ST § 627.669;Eff. 1993 Group and HMO Substance Abuse Mandated Offering The maximum benefit payment for an outpatient visit shall not exceed $35.
GA Coverage of treatment of mental disorders by individual policies;
ST § 33-24-28.1;
ST § 33-24-29.1;
Eff. 1998
Group and Individual Mental disorders including substance abuse Mandated Offering Must be equal
HI  Mental Health and Alcohol and Drug Abuse Treatment Insurance Benefits;
ST § 431M-1 to 431M-7;
Eff.1988
Group and Individual with small employer exemption – 25 or less employees Serious Mental Illness – as defined in most recent DSM Mental Health Parity Must be equal
Amended definition of serious mental illness;
2005 HI Laws Act 140 (SB 761);
Eff. June 21, 2005 
Expands HI ST § 431M-1 ,definition of serious mental illness to include delusional disorders, major depression, obsessive-compulsive disorders, and dissociative disorders Mental Illness Mental Health Parity Must be equal
ID Mental health parity in state group insurance;
ST § 67-5761A;
Eff. July 1, 2006
Health insurance plans for state employees and their family members only Serious mental illness as defined in the DSM. Mental Health Parity Must be equal
IL Mental and emotional disorders;
ST CH 215 § 5/370c;
Eff. July 2, 2010
Group Serious Mental Illness Mental Health Parity Must be equal
IN Treatment limitations or financial requirements on coverage of services for mental illness;
27-13-7-14.8; ST 27-8-5-15.6;
Eff. December 31, 1999
Group, Individual and HMO, small employer exemption 50 or less Mental Illness Minimum Mandated Benefits Must be equal
Group Insurance for Public Employees, Coverage of services for mental illness;
IC 5-10-8-9;
Eff.June 30, 1997
State employees with a small employer exemption 50 or less, or cost increase of 4% or more Mental illness, substance abuse, and chemical dependency Mental Health Parity Must be equal
Coverage of services for a mental illness ;
Indiana House Enrolled Act 1135
Eff. June 30, 2003
Amendment adds substance abuse benefit for those with mental illnesses Substance abuse Minimum Mandated Benefit N/A
IA  Biologically based mental illness coverage;
ST § 514C.22;
Eff. January 1, 2006
Group policies to companies with more than 50 employees, public employees and small businesses that currently have mental health coverage  Biologically based mental illness Minimum Mandated Benefit Must be equal
Mental illness and substance abuse treatment coverage for veterans;
ST § 514C.26;
Eff. January 1, 2011
Group policies to companies with more than 50 employees, public employees and small businesses that currently have mental health coverage Mental Illness and substance abuse Minimum Mandated Benefit Not Specified
KS Kansas mental health parity act; Insurance coverage for services rendered in treatment of alcoholism, drug abuse or nervous or mental conditions;
ST 40-2,105; ST 40-2,105a;
Eff. July 1, 2009 
Group, HMO, Individual and state employee plan Mental illness, alcoholism, drug abuse or substance use disorders Minimum Mandated Benefit Must be equal 
KY Coverage for treatment for mental illness;
ST § 304.17-318 ; ST § 304.38-193;
ST § 304.17A-661; ST § 304.18-036;
ST § 304.32-165;
Eff. July 15, 1986,
Group and HMO, small group and individual plan exempt Mental Illness Mandated Offering Must be equal
LA  Group, blanket, and association health insurance, treatment for alcoholism and drug abuse;
R.S. 22:1025;
Eff. Jan. 1, 2009 
Group Alcoholism and drug abuse Mandated Offering Not Specified
Severe mental illness and other mental disorders;
R.S. 22:1043;
Eff. Jan 1, 2011
Group, HMO and state employee benefit plans. Severe mental illness and other mental disorders Mandated Offering Must be equal
ME   Mental health services coverage;
ST T. 24 § 2325-A;
ST T. 24-A § 2749-C;
§ 2843; § 4234-A;
Eff. 1983
Group with a small employer exception for 20 or less, Individual, and HMO Mental Illness Minimum Mandated Benefits Must be equal
Equitable health care for alcoholism and drug dependency treatment;
ST T. 24-A § 2842;
Eff. 1984
Group with a small employer exemption for 20 employees or less. Alcoholism and drug dependency Minimum Mandated Benefit Must be equal
MD Benefits for treatment of mental illnesses, emotional disorders, and drug and alcohol abuse;
INS § 15-802(click 'code folder', then 'insurance', title 15, section 802);
Eff. October 1, 1997
Group and Individual Mental illness, emotional disorder, drug abuse or alcohol abuse disorder.  Mental Health Parity Must be equal
MA Mental health benefits;
ST 175 § 47B; ST 176A § 8A;
ST 176B § 4A; ST 176G § 4M;
Eff. December 10, 1973
Group, HMO and Individual Biologically Based Mental Disorders as described by the DSM. Minimum Mandated Benefits Not Specified 
MI Treatment for substance abuse;
ST 550.1414a;
Eff. January 1, 1982
Group, HMO and Individual Substance abuse Minimum Mandated Benefits Shall not be less favorable than the maximum prescribed for any other comparable service
MN Mental health services;
ST § 62A.152;
Eff. 1999
Group, HMO and Individual Mental Health and Chemical Dependency Mental Health Parity for plans that offer coverage and HMO’s Must be equal
  MS  Coverage for and Limitations on mental illness;
ST § 83-9-39;
MS ST § 83-9-41;
Eff. January 1, 2001.
Group;Does not apply if it raises costs at least 1%. Mental Illness Minimum Mandated Benefit Not Specified 
Alcoholism treatment, and Limitations on alcoholism coverage;
ST § 83-9-27;
ST § 83-9-29;
Eff. January 1, 1975
Group Alcoholism Minimum Mandated Benefit Not Specified
MO Mental Health and Chemical Dependency Insurance Act;
ST 376.811; ST 376.825 to 376.840; ST 376.1550
Eff. July 10, 1991
Group and Individual Mental illness including alcohol and drug abuse Minimum Mandated Benefit Shall not be unreasonable in relation to the cost of services provided
MT  Coverage of Mental Illness, alcoholism, and drug addiction; ST 33-22-701 to 705;
Eff. September 30, 1987
Group, does not apply if raises cost at least 1% Mental illness, alcoholism, and drug addiction Minimum Mandated Benefit No less favorable up to maximums
Coverage for severe mental illness;
ST 33-22-706;
Eff. 1999
Group and individual Severe Mental Illness Mental Health Parity Must be equal
NE  Mental health conditions;
ST § 44-791 to 44-795;
Eff.1999
Group and HMO with a small employer exception of 15 or less. Mental Illness Minimum Mandated Benefit Varies
Basic coverage for treatment of alcoholism;
ST § 44-780;
Eff. 1980 
Group and HMO Alcoholism Minimum Mandated Benefit No less favorable than the benefits available for the treatment of physical illness generally
NV  Coverage for treatment of conditions relating to severe mental illness;
ST 689A.0455; ST 689C.169;
Eff. July 1, 2000
Group and Individual Severe Mental Illness Minimum Mandated Benefit Must not be greater than 150% of the out-of-pocket expenses
Benefits for treatment of abuse of alcohol and other drugs;
ST 689A.046; ST 689C.167;
Eff. 1979
Group and Individual Alcohol and drug abuse Minimum Mandated Benefit Not Specified
 NH Coverage for Mental or Nervous Conditions and Treatment for Chemical Dependency Required;
ST § 415:18-a;
Eff. 1975
Group, HMO and Individual Mental or nervous conditions Minimum Mandated Benefit Ratio of benefits shall be substantially the same as benefits for other illnesses
Coverage for Certain Biologically-Based Mental Illnesses;
ST § 417-E:1;
Eff. 1994
Group Biologically based mental illness Mental Health Parity Must be equal
  NJ Benefits for treatment of alcoholism;
ST 17:48-6a; ST 17:48A-7a;
ST 17:48E-34; ST 17B:26-2.1;
Eff. July 15, 1985
Group and Individual Alcoholism Mental Health Parity Must be equal
Coverage for biologically-based mental illness;
ST 17:48-6v; ST 17:48A-7u;
ST 17:48E-35.20; ST 17B:26-2.1s;
ST 17B:27-46.1v;
Eff. August 11, 1999
Group and individual Biologically based mental illness Mental Health Parity Must be equal
NM  Alcohol dependency coverage;
ST § 59A-23-6; ST § 59A-47-35;
Eff. July 1, 1999
Group Alcoholism Mandated Offering Co-insurance consistent with those imposed on other benefits within the same policy
Requirement for mental health benefits in a group health plan, or group health insurance offered in connection with the plan, for a plan year of an employer;
ST § 59A-23E-18;
Eff. January 1, 2000
Group Mental Illness[ii]   Not Specified
NY Group or blanket accident and health insurance policies; standard provisions;
INS § 3221(1)(5)(A);
Eff. January 1, 2011
Group Mental, nervous, or emotional disorders and alcoholism and substance abuse. Mandated Offering As deemed appropriate and are consistent with those for other benefits
NC  No discrimination against mentally ill and chemically dependent individuals;
ST § 58-51-55; ST § 58-67-75;
ST § 58-65-90;
Eff. July 1, 1997
State employees health plan Mental Illness and chemical dependency Mental Health Parity Must be equal
Mental illness benefits coverage;
ST § 58-3-220;
Eff. July 1, 2008
Group Mental Illness Minimum Mandated Benefits Varies; see subsection (F)
ND  Group health policy and health service contract substance abuse coverage;
ST 26.1-36-08;
Eff. 1985
Group and HMO Alcoholism, drug addiction or other related illness Minimum Mandated Benefits No deductible or co-pay for first 5 hours not to exceed 20% for remaining hours
Group health policy and health service contract mental disorder coverage;
ST 26.1-36-09;
Eff. 1985
Group and HMO Mental Illness Minimum Mandated Benefits No deductible or co-pay for first 5 hours not to exceed 20% for remaining hours
  OH Policy coverage and group self-insurance for biologically based mental illness;
ST § 3923.281; ST § 3923.282;
Eff. March 30, 2007
Group and self-insured Biologically Based Mental Illness Mental Health Parity Must be equal
Self-insured health care plan; mental disorders; alcoholism;
ST § 3923.30;
Eff. January 1, 1979
Group and self-insured Mental or nervous disorders and alcoholism Minimum Mandated Benefits Subject to reasonable deductibles and coinsurance
OK Severe Mental Illness’
ST T. 36 § 6060.10 (pg 854);
ST T. 36 § 6060.11 (pg 855);
ST T. 36 § 6060.12 (pg 856);
ST T. 36 § 6060.13 (pg 857);
Eff. January 1, 2000
Group[iii] Severe Mental Illness Mental Health Parity Must be equal
OR Coverage for treatment of chemical dependency and for mental or nervous conditions;
ST § 743A.168; ST § 743.556;
Eff. 2007
Group and HMO Mental or nervous conditions including alcoholism and chemical dependency Minimum Mandated Benefits Must be equal
PA Benefits for Alcohol Abuse and Dependency;
40 PA ST § 908-1 through 908-8;
Eff.1990
Group and HMO Alcohol or drug abuse Minimum Mandated Benefits In the first instance of treatment, no co-payment shall be less favorable
RI Mental Illness Coverage;
ST § 27-38.2-1; 2; 3; 4; 5;
Eff. 1994
Group, HMO, Individual and self insured. Mental Illness, including disorders listed by the DSM[iv] Mental Health Parity Must be equal
SC  Mental health insurance/coverage;
ST § 38-71-290; ST § 1-11-780;
Eff. June 30, 2006 
State Employee Insurance Mental health condition or alcohol or substance abuse Mental Health Parity Must be equal
Requirement of coverage for psychiatric conditions in group health insurance policies; "psychiatric conditions" defined;
ST § 38-71-737;
Eff. 1976 
Group Psychiatric conditions, including substance abuse. Mandated Offering. Varies
SD Health insurance policies to provide coverage for biologically-based mental illnesses;
ST § 58-17-98;
Eff. 1998
Group, HMO and Individual Biologically Based Mental Illness Mental health Parity Must be equal
 TN Chemical dependency;
ST § 56-7-2602;
Eff. 1982
Group Alcohol and drug dependency Mandated offering Must be equal
Mental health services coverage; Psychiatric disorders; mental or nervous conditions; chemical dependency;
ST § 56-7-2360; ST § 56-7-2601
Eff. July1, 2000
Group Mental or nervous conditions Minimum Mandated Benefits Must be equal
TX  Benefits for Certain Mental Disorders;
INS Chapter 1355;
Eff. September 1, 2007
Group, HMO Serious Mental Illness Minimum Mandated Benefits Must be equal
Availability of Chemical Dependency Coverage;
INS Chapter 1368;
Eff. April 1, 2005
Group and Self Insured Chemical Dependency Minimum Mandated Benefits Must be equal
UT Catastrophic coverage of mental health conditions;
ST § 31A-22-625;
Eff. March 22, 2010
Group and HMO Mental Illness Mandated Offering May include restriction
VT Health insurance coverage, mental health and substance abuse;
ST T. 8 § 4089b ;
Eff. January 1, 2011
Group and Individual Mental Illnesses and Substance Abuse Mental Health Parity Must be equal
VA Coverage for biologically based mental illness;
ST § 38.2-3412.1:01;
Eff. January 1, 2000
Group and Individual Biologically Based Mental Illness Mental Health Parity Must be equal
WA Mental health services--Definition--Coverage required;
ST 48.21.241;
Eff. January 1, 2008
Group and HMO, except for small employers with between two and 50 employees. Mental Illnesses Mandated Offering Reasonable deductible amounts and co-payments
WV Required policy provisions--Mental Health;
ST § 33-16-3a;
Eff. 2002
Group, HMO and Individual Serious Mental Illness, including disorders listed by the DSM Mental Health Parity Not specified
WI Required coverage of alcoholism and other diseases;
ST 632.89;
Eff. December 1, 2010
Group Mental or nervous disorders Minimum Mandated Benefits Comparable deductibles and co-pays
WY Requirements of accident and sickness insurance to tax supported institutions;
ST § 26-22-102;
Eff. March 7, 2008
Group or Individual Mental Illness Mental Health Parity Not Specified

 

NOTES for state mental health statute table:
A) The Diagnostic and Statistics Manual of the American Psychiatric Association (DSM) includes universally accepted definitions and descriptions of mental illnesses and conditions. There are 13 DSM diagnoses commonly referred to as biologically-based mental illnesses by mental health providers and consumer organizations. Between 3 and 13 of these diagnoses are referred to in various state parity laws. For example, in Alabama, mental illness is defined as: 1) schizophrenia, schizophrenia form disorder, schizo-affective disorder; 2) bipolar disorder; 3) panic disorder; 4) obsessive-compulsive disorder; 5) major depressive disorder; 6) anxiety disorders; 7) mood disorders; 8) Any condition or disorder involving mental illness, excluding alcohol and substance abuse, that falls under any of the diagnostic categories listed in the mental disorders section of the International Classification of Disease, as periodically revised.

B) NAIC Mental Illness Treatment tally.  The National Association of Insurance Commissioners lists 46 states with mandated requirements, not mentioning AK, AZ, MI and WY, as of February 2008.

C) Examples of "Barebones" exception laws:

  • Colorado H 1164
  • Texas S 541 of 2003
  • Montana H 384 of 2003

of 2003 allows small employers to purchase a basic health benefit plan that does not include mental health and substance abuse treatment mandates. 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 if the plan is issued to a large employer. An insurer that offers such policy must also offer at least one policy with state-mandated health benefits. allows for a 12-month demonstration project that in some cases, permits a limited coverage plan or managed care plan without mandates for mental illness

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."  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."

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
Two new resources from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured explore key aspects of mental health care financing and access. Medicaid plays an important role in financing mental health services in the United States and will play a key role in ensuring access to behavioral health services under the health reform law.

Mental Health Financing in the United States: A Primer, provides an overview of behavioral health care, reviews the sources of financing for such care, assesses the interaction between different payers and highlights recent policy debates in mental health. It also discusses the role of Medicaid, currently the largest source of financing for behavioral health services in the nation, covering a quarter of all expenditures. This comprehensive resource serves as a guide for those who want to understand the complex system of behavioral health financing in the United States.

Medicaid Policy Options for Meeting the Needs of Adults with Mental Illness under the Affordable Care Act, examines the salient issues raised in a recent roundtable discussion of national and state experts convened by the Commission, in partnership with the Bazelon Center for Mental Health Law, to discuss Medicaid policy options available under health reform to help meet the needs of adults with mental illness. The Patient Protection and Affordable Care Act will expand the Medicaid program, offering the opportunity to improve access to care for millions of Americans with mental health disorders. States face several decisions about designing benefits, structuring service delivery and conducting outreach and enrollment for this population, which has unique health and social service needs. This report highlights key policy opportunities and challenges related to these decisions. The discussion was the latest in an ongoing series of Health Reform Roundtables that explore key issues related to implementing the expansion of Medicaid under health reform. 


Footnotes from table

[i] Does not include mental retardation, learning disorders, communication disorders, relational disorders, motor skills disorder, caffeine-related disorders, etc.

[ii] Does not apply to benefits for treatment of substance abuse, chemical dependency or gambling addiction.

[iii] A health plan that experiences a greater than 2% increase  in costs pursuant to providing treatment for severe mental illness is exempt from requirement.

[iv] Does not cover mental retardation, motor skills disorders or communication disorders.

Authors:  Richard Cauchi, Program Director, Steven Landess & Andrew Thangasamy, staff researcher, NCSL Health Program, Denver.

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