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This page lists some of the action toward parity compliance undertaken by Alabama regulatory agencies since 2008.

Are we missing any actions taken by state regulatory agencies? Let us know at info@paritytrack.org

Action in the Regulatory Arena

Every year all insurance plans besides individual plans are required to submit a form called the Alabama Group Mental Health Parity Cost Report (pdf | Get Adobe® Reader®) that certifies that they meet the requirements of the section of the insurance law about parity. It also requires insurers to provide a cost comparison between their plans that cover mental health services and their plans that do not. Plans must submit this form by April 30 each year.

7/2017

Primary Focus:  Mandated Benefit: Provider
Agency: Medicaid
Title/Description:  Service Delivery Network Requirements
Citation:  Ala. Admin. Code r. 560-X-64-.17
Summary: The Integrated Care Network (ICN) must establish agreements with the Alabama Department of Mental Health (ADMH) to ensure that each ICN establishes and maintains an adequate network of ADMH certified behavioral health providers to appropriately address the needs of enrollees who have mental illnesses and substance abuse disorders. The ICN provider network must include ADMH-certified mental health and substance abuse providers.
Effective Date: July 14, 2017

1/2016

Primary Focus:  Mandated Benefit: Provider
Agency: Medicaid
Title/Description: Covered Services: Details on Selected Services
Citation: Ala. Admin. Code r. 560-X-6-.13
Summary: Group Therapy shall be a covered service when a psychiatric diagnosis is present and the therapy is prescribed, performed, and billed by the physician personally. Group Therapy is included in the annual office visit limit. Family Therapy shall be a covered service when a psychiatric diagnosis is present and the physician providing the service supplies documentation which justifies the medical necessity of the therapy for each family member. Family therapy is not covered unless the patient is present. Family Therapy is included in the annual office visit limit. Family Therapy is not covered when performed by a case worker, social service worker, mental health worker, or any counseling professional other than a physician.
Effective Date: October 1, 1982; Last amended January 11, 2016

8/2014

Primary Focus: Medicaid
Agency: Medicaid
Title/Description: Service Delivery Network Requirements
Citation: Ala. Admin. Code r. 560-X-62-.12
Summary: The Regional Care Organization/Alternative Care Provider (RCO/ACP) members must establish agreements with the Alabama Department of Mental Health (ADMH) to ensure that each RCO/ACP establishes and maintains an adequate network of ADMH certified behavioral health providers to appropriately address the needs of beneficiaries in the demonstration populations who have mental illnesses and substance abuse disorders. The RCO/ACP provider network must include ADMH-certified mental health and substance abuse providers.
Effective Date: August 22, 2014

2009

The Alabama Department of Insurance (DOI) issued a bulletin (pdf | Get Adobe® Reader®) informing insurance plans that they have to comply with the Federal Parity Law or the plan will not be approved for issuance in the state of Alabama.

2/1999

Primary Focus:  Mandated Benefit: Provider
Agency: Department of Public Health
Title/Description:  Basic Health Care Services
Citation:  Ala. Admin. Code r. 420-5-6-.04
Summary:  A health maintenance organization may provide, in addition to basic health services, other health services such as outpatient substance abuse services, residential treatment for substance abuse or mental health at recommended levels of 30 days for adults and 60 days for adolescents.
Effective Date: March 31, 1987; Last amended February 24, 1999

Alabama Parity Law

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.

Mental Health

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.”

Autism

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.

Get Support

Alabama Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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