Alabama

The sections of Alabama law relevant to parity are found in the state insurance law. There is a section about mental health coverage and a section about autism coverage. Substance use disorder services are excluded.

It is not possible to provide direct links to sections of Alabama law due to the functionality of the state’s website. To find the section on mental health coverage go to this link and then click on the left side of the page; click on Title 27; then click on chapter 54. You can then click on each subsection of this section.

This section (27-54-4) requires large employer fully-insured plans to offer optional mental health coverage that large employers can accept or reject. Small employer plans and individual plans do not have to comply with this section of the insurance law.

This section (27-54-4) includes all mental health conditions listed in the mental disorders section of International Classification of Diseases. However, it explicitly states that substance use disorders are excluded. It also specifically mentions these conditions:

• Schizophrenia, schizophrenia form disorder, schizoaffective disorder.
• Bipolar disorder.
• Panic disorder.
• Obsessive-compulsive disorder.
• Major depressive disorder.
• Anxiety disorders.
• Mood disorders.

This section (27-54-3) makes clear that inpatient care, outpatient care, and partial hospitalization (“day treatment”) are included. These services must be on “terms and conditions that are no less extensive” than other medical services.

The section (27-54-4) also states that insurance plans must “use the same criteria” for medical necessity for mental health treatment as they use for other medical treatment.

Each plan affected by this section (27-54-6) of the law is required to file an annual cost report with the Commissioner of Insurance that includes “certification of parity in mental health benefits.”

It is not possible to provide direct links to sections of Alabama law due to the functionality of the state’s website. To find the section on autism coverage go to this link and then click on the left side of the page; click on Title 27; then click on chapter 54A. You can then click on each subsection of this section.

This section requires large employer fully-insured plans to offer optional autism coverage for children through age 9 that large employers can accept or reject. It defines autism spectrum disorder as any pervasive developmental disorder listed in the DSM and specifically mentions:

• Autistic Disorder
• Asperger’s Disorder
• Pervasive developmental disorder not otherwise specified

Treatment for autism spectrum disorder is defined as:

• Behavioral health treatment
• Psychiatric care
• Psychological care
• Therapeutic care
• Pharmacy care

All of these are defined in more detail in this section of the law.

This optional coverage is required to include a $36,000 annual maximum for applied behavior analysis, which will be adjusted for inflation each year.

Annual maximums, lifetime maximums, deductibles, and coinsurance must be the same as what is in place for other medical services.

Insurance plans are only allowed to review a child’s treatment plan once every 6 months.