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This page lists some of the action toward parity compliance undertaken by Delaware 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

The Delaware Department of Insurance issues a submission guide (pdf | Get Adobe® Reader®) for insurers who want to sell qualified health plans on the individual and small group market. This guide explains that plans must comply with the Federal Parity Law and the parity sections of the state insurance law (page 16). It informs plans that the Department will be reviewing all plans to make sure that they comply with state and federal parity laws (page 16). It also requires plans to fill out a checklist to demonstrate their compliance with the Federal Parity Law and the parity sections of the state insurance law (pages 52 and 53).

2018

Primary Focus: Federal Compliance
Agency: Delaware Health and Social Services (“Department”) / Division of Medicaid and Medical Assistance
Title/Description: Title XXI CHIP Compliance with MHPAEA
Citation: 21 DE Reg. 805
Summary: The Delaware Health and Social Services (“Department”) / Division of Medicaid and Medical Assistance submitted proposal DE 3290 to amend Title XXI CHIP Plan regarding MHPAEA specifically, to align the Delaware CHIP Plan with new Federal Requirements. The purpose of the proposed regulation was to ensure that coverage provided to CHIP beneficiaries for mental health and substance use disorders was no more restrictive than coverage for medical/surgical conditions. The final order for 21 DE Reg. 805 was issued on April 4, 2018 via DE 3357.
The regulation covers how the state determines whether each covered benefit is a medical/surgical, mental health, or substance use disorder. It categorizes each benefit as inpatient, outpatient, emergency care, and a prescription drug. The regulation also lists the annual and aggregate lifetime dollar limits for benefits covered under the State child health plan. In addition it ensures that NQTLs comply with parity requirements and that information on medical necessity criteria and denials of payment or reimbursements are available. Attachments cover benefits by classification, NQTL analysis, and cost-sharing methodology.
Effective Date: April 11, 2018
Notes: N/A

2/2013

The Delaware Department of Insurance gave a presentation (pdf | Get Adobe® Reader®) to insurers about the state exchange and the qualified health plan certification process. Slide 35 addressed what is required by the Federal Parity Law for plans on the exchange in 2014.

Delaware Parity Law

There are 5 sections of the state insurance law relevant to parity. There are two identical sections for coverage of certain behavioral health conditions, and two identical sections for coverage of autism. There is also a section that requires large employer fully-insured plans to comply with an older version of the Federal Parity Law, known as the Mental Health Parity Act of 1996. However, that section does say that plans must comply with “any subsequent changes in federal law,” which could be interpreted as requiring plans to comply with the current Federal Parity Law.

It is not possible to provide a direct link to any of these sections. To find the sections that apply to individual plans, click here and scroll to “§ 3343 Insurance coverage for serious mental illness” for the behavioral health section and “§ 3366 Autism spectrum disorders coverage” for the autism section.

To find the sections that apply to employer plans, click here and scroll to “§ 3578 Insurance coverage for serious mental illness” for the behavioral health section and click here and scroll to “§ 3570A Autism spectrum disorders coverage” for the autism section.

To find the section that requires large employer fully-insured plans to comply with the previous Federal Parity Law, click here and scroll to “§ 3576 Mental health parity”

Behavioral Health

These sections require individual plans, small employer fully-insured plans, and large employer fully-insured plans to cover services for the following conditions, as defined in the DSM :

  • Schizophrenia
  • Bipolar disorder
  • Obsessive-compulsive disorder
  • Major depressive disorder
  • Panic disorder
  • Anorexia nervosa
  • Bulimia nervosa
  • Schizoaffective disorder
  • Delusional disorder
  • Substance use disorders (“drug and alcohol dependencies”)

Deductibles, copayments, coinsurance, annual maximums, lifetime maximums, inpatient day limits, outpatient visit limits, any other durational limits, and coverage for prescription medication for the listed behavioral health conditions must not “place a greater financial burden” than those in place for other medical services.

Plans are explicitly allowed to use non-quantitative treatment limitations (NQTLs) and other managed care techniques in ways that are “unique to mental health benefits.” It also states “This section shall not be interpreted to require a carrier to employ the same benefit management procedures for serious mental illnesses and drug and alcohol dependencies that are employed for the management of other illnesses”. This could be interpreted to mean that NQTLs can be used more frequently or more restrictively.

These sections do not apply to out-of-network behavioral health services.

Autism Coverage

These sections require individual plans, small employer fully-insured plans, and large employer fully-insured plans to cover autism services through age 20. Plans must cover an annual maximum of $36,000 for applied behavior analysis, which can be adjusted for inflation each year.

Plans cannot have any outpatient visit limits and financial requirements must be the same as those in place for other medical services.

Autism spectrum disorders are defined as “pervasive developmental disorders as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), including Autistic Disorder, Asperger’s Disorder and Pervasive Developmental Disorder Not Otherwise Specified.”

Treatments for autism are listed as (and defined in this section):

  • Behavioral health treatment (applied behavior analysis )
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care

Insurance plans may only review a child’s treatment plan once per year.

These sections also require the Secretary of the Department of Health and Social Services to review best practices and evidence-based research regarding medically necessary care for autism and inform the Commissioner of the Department of Insurance of these findings. The Commissioner is then required to issue a bulletin to plans informing them of the latest medically necessary treatments for autism they must cover.

Get Support

Delaware 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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