Health Insurance Parity for Alcohol-Related Treatment

On July 31, 2009, Arkansas adopted provisions designed to bring its insurance laws into conformity with the Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended by the Federal Mental Health Parity Act of 1996 (MHPA) and the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). These provisions do not require mental illness or substance abuse disorder benefits coverage. However, if a plan provides coverage for mental illness or substance abuse disorder benefits, then these benefits must be equal to physical illness benefits in certain respects. Such provisions are not coded in APIS.

141 Laws of Delaware 199 (2001), which implemented insurance coverage for drug and alcohol dependencies, became effective July 1, 2005. To permit insurance carriers a reasonable amount of time for implementation, this act was made to apply to “all policies, contracts, certificates or programs issued, renewed, modified, altered, amended or reissued on after [sic] January 1, 2006.” See 143 Laws of Delaware 89 (2005).

Alcohol abuse is included within the definition of "mental health condition" in Ky. Rev. Stat. Ann. § 304.17A-660(1). Although Ky. Rev. Stat. Ann. § 304.17A-661(1) states that, if coverage for any such condition is provided, it must be provided “under the same terms or conditions as provided for treatment of a physical health condition,” Ky. Rev. Stat. Ann. § 304.17A-669(1) makes it clear that such provisions are not to be construed as mandating coverage for mental health conditions. The provisions of Ky. Rev. Stat. Ann. §§ 304.18-130 to 304.18-170 require only that minimum benefits for the treatment of alcoholism be offered.

The Must Offer mandate began to apply to both Fee-for-Service (Traditional Insurance) policies and Managed Care policies on May 28, 2003. Prior to that date, the Must Offer mandate applied only to Fee-for-Service (Traditional Insurance) policies.

Maine's mental health parity statutes were amended in 2003 to bring "substance abuse-related disorders,” including alcohol-related disorders, within the state's broad mental health parity requirements. Other, more limited, provisions for alcoholism and drug dependency treatment that preceded this amendment also remain in effect.

The benefits provided under Maryland law are required only for expenses arising from the treatment of mental illnesses, emotional disorders, drug abuse, or alcohol abuse if, in the professional judgment of health care providers: (1) the mental illness, emotional disorder, drug abuse, or alcohol abuse is treatable; and (2) the treatment is medically necessary.

Prior to July 1, 2016, insurers, health maintenance organizations, and health care corporations were mandated to offer inpatient care and to cover intermediate and outpatient care with a cost exemption permitted. Beginning July 1, 2016: (1) insurers and health maintenance organizations are only mandated to cover intermediate and outpatient care; and, (2) health care corporations continue to be mandated to offer inpatient care and to cover intermediate and outpatient care with a cost exemption permitted.

Prior to August 1, 2008, health plans were required to provide alcoholism treatment coverage "on the same basis as coverage for other benefits." Minnesota law also specified that alcoholism treatment in hospitals and residential treatment programs be covered for at least 20 percent of the total patient days allowed by the policy, and for not less than 28 days annually, and required that alcoholism treatment in nonresidential treatment programs be covered for at least 130 hours annually. Beginning on August 1, 2008, these minimum coverage requirements were repealed and the law now requires that cost-sharing requirements and benefit or service limitations for inpatient and outpatient chemical dependency and alcoholism services not place a greater financial burden on the insured or be more restrictive than the requirements and limitations applicable to medical services.

Prior to July 1, 2014, parity with respect to cost-sharing was only required as to inpatient treatment. See Miss. Code Ann. § 83-9-41(3).

Pursuant to Mo. Rev. Stat. § 376.779, all group health insurance policies providing coverage on an expense-incurred basis, all group service or indemnity contracts issued by a not-for-profit health service corporation, all self-insured group health benefit plans, of any type or description, and all such health plans or policies that are individually underwritten or provide for such coverage for specific individuals and the members of their families as nongroup policies, which provide for hospital treatment, shall provide coverage, while confined in a hospital or in a residential or nonresidential facility certified by the department of mental health, for treatment of alcoholism on the same basis as coverage for any other illness, except that coverage may be limited to thirty days in any policy or contract benefit period. In addition, pursuant to Mo. Rev. Stat. § 376.811, every insurance company and health services corporation doing business in Missouri shall offer in all health insurance policies certain benefits or coverage for chemical dependency, subject to the same coinsurance, co-payment and deductible factors as apply to physical illness. If such coverage is selected, this shall substitute for the coverage under Mo. Rev. Stat. § 376.779. If such coverage is rejected, then the provisions of the Mental Health and Chemical Dependency Insurance Act apply. Prior to August 28, 2014 the Mental Health and Chemical Dependency Insurance Act applies only if a health insurance policy provides certain coverage for mental illness, including alcohol and drug abuse. If such coverage is provided, then (subject to the cost exemption in Mo. Rev. Stat. § 376.833, subsection 2) it must meet certain minimum standards (see Mo. Rev. Stat. §§ 376.826 – 376.830), which may also substitute for the coverage required under Mo. Rev. Stat. § 376.779.

The Must Cover mandate applies only to fee-for-service (traditional insurance) policies and not to managed care policies.

Section designations in the Oregon Code were renumbered by the Oregon Legislative Counsel for the 2007 printed edition of the statutes, which was delivered in December 2007. Or. Rev. Stat. § 743.556 was renumbered to Or. Rev. Stat. § 743A.168 as part of this effort. Section designations in the Oregon Code were also renumbered by the Oregon Legislative Counsel in 2015. Or. Rev. Stat. §§ 743.730 and 743.736 were renumbered to Or. Rev. Stat. §§ 743B.005 and 743B.012 respectively as part of this effort.

South Dakota's Must Offer mandate, as well as its alcohol-related parity requirements, apply only to inpatient treatment.

With respect to cost sharing, Utah requires parity for "maximum out-of-pocket limits" only. Utah requires parity with respect to annual dollar limits, but not lifetime dollar limits. Between February 8, 2008 and August 13, 2009, “Basic Health Care Plans” in Utah were required to cover "limited substance abuse services."

Prior to the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), benefits for substance abuse or chemical dependence were excluded from the Federal parity law. Under MHPAEA, if an employer of more than 50 persons provided mental health or substance use disorder benefits to employees, the mental health or substance use disorder benefits were required to be equal to benefits for medical and surgical care in certain respects. Importantly, however, MHPAEA did not require an employer to provide mental health or substance use disorder benefits. Beginning on January 1, 2014, however, the Affordable Care Act (ACA) requires all individual and small group health plans created after March 23, 2010 to include coverage for mental health and substance use disorders, including alcohol-related disorders, as one of ten categories of Essential Health Benefits, and this coverage is required to comply with Federal parity requirements. For additional information, including citations and relevant statutory excerpts, please see Federal Law for this policy topic.