| Source: |
Adapted from Gitterman, Daniel, Richard Scheffler, Marcia Peck, Elizabeth
Ciemans, and Darcy Gruttadero. "A Decade of Mental Health Parity: The
Regulation of Mental Health Insurance Parity in the United States, 1990-2000." NIMH Grant MH-18828-11. Berkeley: University of California,
July 2000. Updated based on State parity legislative information from the
General Accounting Office, "Mental Health Parity Act: Despite New Federal
Standards, Mental Health Benefits Remain Limited," GAO/HEHS-00-95,
May 2000; the National Association for the Mentally Ill (NAMI), August 2001;
and the NCSL Health Policy Tracking Service "Mental Health Parity"
brief, December 2001. |
| a |
A "mandated benefit" refers to State statutes that require health
insurance policies to include certain benefit provisions. A typical provision
states that a group health plan shall provide benefits for diagnosis and
mental health treatment under the same terms and conditions as provided
for physical illnesses. States that are not checked under this column have
either a "mandated benefit offering" or a "mandated, if offered"
provision. The "mandated benefit offering" provision requires
sellers to offer certain types of mental health coverage, with the decision
of whether to purchase coverage left to the buyers. Alabama, Georgia, and
Missouri have "mandated benefit offering" provisions. The "mandated,
if offered " provision does not require the employer or insurer to
offer mental health coverage; however, if the employer offers coverage,
then the coverage must comply with parity provisions. Indiana, Kentucky,
and Nebraska have "mandated, if offered" provisions. |
| b |
"Broad definition of mental illness" is defined as encompassing
all the disorders listed in the American Psychiatric Association's Diagnostic
and Statistical Manual of Mental Health Disorders and/or the International
Classification of Diseases Manual. For States that are not checked in this
column, some narrow their laws' scope by requiring coverage only for "biologically
based" illness or "serious mental illness," most commonly
defined as schizophrenia, bipolar disorder, obsessive-compulsive disorder,
major depressive disorder, panic disorder, schizo-affective disorder, and
delusional disorder. Alternatively, some States - as well as the Federal
Mental Health Parity Act - allow health plans to define the scope of the
mental health benefit. |
| c |
States that are not checked in this column permit a disparity in the terms
and conditions required for mental health coverage compared to other physical
health conditions (for example, allowing a cap on the number of inpatient
days and/or outpatient visits for mental health coverage that differs from
that for other physical illnesses).
|
| d |
States that are not checked in this column permit a disparity between
the cost sharing for mental health services and physical health services. |
| e |
States that are not checked in this column exempt small employers, most
commonly defined as employers with either 25 or fewer employees or 50 or
fewer employees. |
| f |
Arkansas: S. 716 (2001) prohibits health plans from imposing limits on
coverage for mental health treatment offered by employers with 50 or fewer
employees. This law allows groups of 51 or more employees to impose an annual
maximum of 8 inpatient/partial hospitalization days together with 30 outpatient
days. |
| g |
Illinois: S. 1341 requires "group health benefit plans to provide
coverage based upon medical necessity for the following treatment of mental
illness in each calendar year: 45 days of inpatient treatment and 35 visits
for outpatient treatment, including group and individual outpatient treatment,
and prohibits a lifetime limit on the number of inpatient treatment days
and outpatient visits covered by the plan. Plans must include the same amount
limits, deductibles, copayments, and coinsurance factors for serious mental
illness as for physical illness." |
| h |
Indiana: Statute specifies a "mandated benefit" for State employee
plans and a "mandated offering" for group and individual plans. |
| i |
Indiana, North Carolina, and South Carolina: The parity statute applies
to health plans offered to State employees. |
| j |
Maine: The statute mandates coverage for group plans and requires a mandated
offering for individual policies. |
| k |
Massachusetts: Parity for substance abuse applies only in cases of co-occurring
mental illness and substance abuse disorders. |
| l |
Minnesota: The statute mandates coverage for health maintenance organizations
(HMOs) and "mandated, if offered" for individual and group plans. |
| m |
Nevada: Annual and lifetime dollar limits must be equal to other illnesses;
cost sharing for copayments and coinsurance must not be more than 150 percent
of out-of-pocket expenses for medical and surgical benefits. |
| n |
Pennsylvania: Statute requires parity in annual and lifetime dollar limits
but only specifies that cost sharing "must not prohibit access to care." |
| o |
Texas: Statute requires "mandated benefits" for group and HMO
plans and a "mandated offering" for groups of 50 or fewer. |
| p |
The Federal Mental Health Parity Act allows health plans to define the
covered illnesses. |