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Legislation Signed into Law

2020

Primary Focus: Compliance; Enforcement and Oversight; Access
Title/Description: Mental Health Parity
Citation: A.R.S. §§ 20-3501 — 20-3505
Summary: This law requires insurance companies to comply with the Mental Health Parity and Addiction Equity Act of 2008. It requires insurers to submit detailed analyses on their compliance with the Federal Parity Act, including for each non-quantitative treatment limitation in each classification of care consistent with the six-step process. Reports on criteria must be submitted every three years, and regulators will then evaluate reports for compliance and enforce/respond accordingly. The law also outlines new requirements for member identification cards, including listing information that facilitates access to services or coverage. It also creates the Children’s Behavioral Services Fund and provides $8 million for behavioral health services for uninsured and/or underinsured children. The bill also prohibits insurance companies from denying coverage for services covered by a plan simply because they are delivered in an educational setting. Other provisions include a Mental Health Parity Advisory Committee and a Suicide Mortality Review Team.
Effective Date: 3/3/2020
Notes: N/A

2018

Primary Focus: Telemental Health and Disability Insurance
Title/Description: Telemedicine: Coverage of Health Care Services
Citation: ARIZ. REV. STAT. ANN. § 20-1376.05
Summary: ARIZ. REV. STAT. ANN. § 20-1376.05 requires disability insurance policies to cover health care services that are provided through telemedicine if those health care services would be covered had they been provided through in-person consultation. “Health care services” is defined in the statute as including mental health services, meaning insurers must provide equivalent coverage for mental health services provided through telemedicine. Disability insurers may impose deductibles, copays or coinsurance requirements as long as they do not exceed the deductible, copayment or coinsurance applicable to an in-person mental health consultation. However, disability insurers may limit the coverage to health care providers who are members of the insurer’s provider network.
Effective Date: January 1, 2018
Notes: N/A

Primary Focus: Behavioral Health Programs Authority
Title/Description: Transfer of Department Jurisdiction
Citation: A.R.S. § 36-2901.07 and A.R.S. §41-3803
Summary: A.R.S. § 36-2901.07 was amended to transfer the responsibility of establishing a diagnostic and evaluation program to which other state agencies can refer children who are not already enrolled and who may be in need of behavioral health services from the Department of Health Services to the administration acting through the regional behavioral health authorities. Additionally, A.R.S. §41-3803 was amended to transfer jurisdiction of the Human Rights Committee on the Mentally Ill from the Department of Health Services to the Arizona Health Care Cost Containment System.
Effective Date: May 17, 2016
Notes: The above referenced statutes were amended pursuant to AZ S. 1251.

Section 36-2901.07 is repealed if the below condition is met:

“1. From and after the date the federal medical assistance percentage pursuant to 42 United States Code section 1396d(y) or 1396d(z) that is applicable to this state is less than eighty per cent. 2. If the patient protection and affordable care act established pursuant to Public Law 111-148, as amended by the health care and education reconciliation act of 2010 pursuant to Public Law 111-152, is repealed. 3. If the maximum amount that can be assessed under section 36-2901.08, Arizona Revised Statutes, as added by this act, without causing a reduction in federal financial participation, in combination with the monies specified in section 36-2901.09, Arizona Revised Statutes, as added by this act, and any other monies appropriated for the costs for the populations specified in section 36-2901.08, subsection A, Arizona Revised Statutes, as added by this act, is insufficient to cover the costs described in section 36-2901.08, Arizona Revised Statutes, as added by this act. B. The Arizona health care cost containment system administration shall notify the director of the Arizona legislative council in writing of the effective date if: 1. The federal medical assistance percentage under 42 United States Code section 1396d(y) or 1396d(z) that is applicable to this state is less than eighty per cent. 2. The patient protection and affordable care act established pursuant to Public Law 111-148, as amended by the health care and education reconciliation act of 2010 pursuant to Public Law 111-152, is repealed. 3. The maximum amount that can be assessed under section 36-2901.08, Arizona Revised Statutes, as added by this act, without causing a reduction in federal financial participation, in combination with the monies specified in section 36-2901.09, Arizona Revised Statutes, as added by this act, and any other monies appropriated for the costs for the populations specified in section 36-2901.08, subsection A, Arizona Revised Statutes, as added by this act, is insufficient to cover the costs described in section 36 2901.08, Arizona Revised Statutes, as added by this act.”

As of August 9, 2017, the condition had not been met.

Arizona Parity Law

There is a section in the state insurance law relevant to parity and several sections about coverage for autism services.

Mental Health Coverage

This section of the insurance law applies to mental health services and explicitly does not apply to substance use disorder services. This section only applies to large employer fully-insured plans.

Plans are not required to cover mental health services, but if they do, the following is required regarding annual maximums and lifetime maximums:

OR

There is nothing in this section of the law that addresses treatment limitations or other financial requirements .

Autism Coverage

There are four sections of the insurance law about coverage for autism services. They can be found here, here, here, and here.

These sections only apply to large employer fully-insured plans. Plans cannot use different deductibles or coinsurance for autism services.

Plans must cover $50,000 of “behavioral therapy” each year for children through age 8, and $25,000 for children age 9 through 16. “Behavioral therapy” includes applied behavior analysis.

Autism Spectrum Disorder is defined as autistic disorder, Asperger’s syndrome, and pervasive developmental disorder not otherwise specified.

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Arizona Insurance Division

Common Violations

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

Common Violations

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