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

2018

Primary Focus: Narcotic Treatment Programs
Agency: Department of Community Health
Title/Description: Narcotic Treatment Programs Central Registry
Citation: Ga. Comp. R. & Regs. R. 111–8–53–.19
Summary: To prevent simultaneous enrollment of a patient in more than one program, all programs shall participate in the Central Registry approved by the Department and operated by the Department of Behavioral Health and Developmental Disabilities and shall comply with any policies, procedures or rules of the Department of Behavioral Health and Developmental Disabilities which are associated with the Central Registry. Patients must be informed of the program’s participation in the Central Registry, and prior to initiating a Central Registry inquiry, the program must obtain the patient’s signed consent. Reports received by the Central Registry shall be treated as confidential and shall not be released except to a licensed program or as required by law. Information made available by the Central Registry to program shall also be treated as confidential.
To prevent simultaneous enrollment of persons in different programs located in different states, if a program operates within 125 miles of any adjoining state and that stat also has a Central Registry, the program shall participate in the Central Registry of the adjoining state, if available.
Effective Date: 03/07/2018
Notes: Original Rule entitled “Central Registry” adopted Sep. 9, 2013. Amended Feb. 15, 2018, effective March 7, 2018.

6/2015

The Georgia Office of Insurance and Safety Fire Commissioner issued a bulletin (pdf | Get Adobe® Reader®) informing plans of their requirements for covering autism services. It specifically stated that plans must cover $30,000 per year of applied behavior analysis for children with autism through age 6. It also notified plans that the Office would be collecting information from them about autism coverage for the Office’s annual report on autism coverage.

Georgia Parity Law

There are several sections of the state insurance law relevant to parity. Three for behavioral health coverage and one for autism coverage:

It is not possible to provide direct links to any of these sections. To find them, click here. Then scroll down and click on the plus sign (+) next to “Title 33”. Then scroll down and click on the plus sign (+) next to “Chapter 24”. Then click on the plus sign (+) next to “Article 1. General Provisions”. Then scroll to the section you want from our list above.

Behavioral Health Coverage

Individual Plans

Individual plans are required to offer optional coverage for behavioral health services that is “at least as extensive” as coverage for other medical services.

Plans cannot have “any exclusions, reductions, or other limitations” or financial requirements for behavioral health services that are not in place for other medical services, except that plans must only cover 30 days of inpatient care and 45 visits for outpatient care.

Small Employer Fully-Insured Plans

Small employer fully-insured plans are required to offer optional coverage for behavioral health services “at least as extensive” as coverage for other medical services.

Annual maximums and lifetime maximums must be the same for behavioral health services and other medical services.

Plans cannot have “any exclusions, reductions, or other limitations” for behavioral health services that are not in place for other medical services, except that plans may limit days for inpatient care and visits for outpatient care. It does not specify any number for either of these limitations.

Except for deductibles, plans are allowed to have financial requirements for behavioral health services that are not in place or are different that those in place for other medical services.

Large Employer Fully-Insured Plans

Large employer fully-insured plans are required to offer optional coverage for behavioral health services “at least as extensive” as coverage for other medical services.

Annual maximums and lifetime maximums must be the same for behavioral health services and other medical services.

Plans cannot have “any exclusions, reductions, or other limitations” for behavioral health services that are not in place for other medical services, explicitly including limits for inpatient care and visits for outpatient care. It does not specify any number for either of these limitations.

Except for deductibles, plans are allowed to have financial requirements for behavioral health services that are not in place or are different that those in place for other medical services.

Autism Coverage

This section requires individual plans, small employer fully-insured plans with more than 10 employees, large employer fully-insured plans and state employee plans to cover autism services through age 6.

There is a $30,000 annual maximum for applied behavior analysis, but plans may not limit outpatient visits otherwise.

Plans can review a child’s treatment plan once a year.

Autism spectrum disorder is defined as it is in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.

Treatment of autism is defined as:

  • Habilitative or rehabilitative services
  • Counseling services provided by a licensed psychiatrist, licensed psychologist, professional counselor, or clinical social worker
  • Therapy services provided by a licensed or certified speech therapist, speech-language pathologist, occupational therapist, physical therapist, or marriage and family therapist

Plans can file for an exemption if they can prove that complying with this section of the law caused premiums to increase by 1% or more over a 12-month time span.

Get Support

Georgia 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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