Primary Focus: Mandated Benefit; SUD; Medicaid Title/Description: Substance use disorder treatment benefit Citation: Ky. Rev. Stat. Ann. § 205.6311 Summary: The Department for Medicaid Services shall provide a substance use disorder benefit consistent with federal laws and regulations which shall include a broad array of treatment options for those with heroin and other substance use disorders. Effective Date: March 25, 2015 Notes: Enacted by Ky SB 192.
Status: Signed into law 4/2010 Summary: Among other things, this bill changed the sections of the insurance law about autism coverage to what they are currently (these sections are summarized at the bottom of this page under “Kentucky Parity Law,” “Autism Coverage”).
Primary Focus: Parity General Title/Description: Treatment of mental health conditions to be covered under same terms and conditions as treatment of physical health conditions. Citation: Ky. Rev. Stat. Ann. § 304.17A-661 Summary: Any health benefit plan issued or renewed after July 14, 2000, that provides coverage for treatment of a mental health condition shall provide coverage of any treatment for a mental health condition under the same terms or conditions as provided for treatment of a physical health condition. Effective Date: July 14, 2000 Notes: Enacted by Ky. HB 268.
Kentucky Parity Law
There are multiple sections in the state law about parity and two sections about autism coverage. They will be summarized as follows:
Behavioral health coverage
Mental health coverage
Alcohol use disorder coverage
Behavioral Health Coverage
This section and this section require large employer fully-insured plans to offer optional behavioral health coverage. If the employer chooses the optional coverage, the coverage must be on the “same terms and conditions” as coverage for other medical services. Terms or conditions is defined as including:
Inpatient day limits
Outpatient visit limits
Annual maximums and lifetime maximums
Copayments and coinsurance
Out-of-pocket limits, and any other cost-sharing requirements
Treatment of behavioral health conditions is defined as including inpatient care, outpatient care, partial hospitalization, residential treatment, crisis stabilization, and emergency care.
Deductibles for behavioral health services should be part of one, overall deductible for all medical services.
Plans are allowed to use managed care for behavioral health coverage to a greater extent than they do for other medical coverage.
Any violations of these sections of the law are considered “an act of discrimination and shall be
an unfair trade practice under this chapter.”
Mental Health Coverage
This section and this section require individual plans and small employer fully-insured plans to offer optional coverage for mental health conditions. This coverage should include inpatient care and outpatient care and must be “to the same extent and degree” as coverage for other medical care.
Alcohol Use Disorder Coverage
This section requires small employer fully-insured plans to offer optional coverage for treatment of alcoholism. This coverage includes emergency detoxification, residential treatment, and outpatient care. However, plans do not have to pay for any services if the patient does not complete the treatment program. The following are required for these services:Detoxification:
3 days and $40 per day
Residential treatment: 10 days and $50 per day
Outpatient care: 10 visits and $10 per visit
This section requires large employer fully-insured plans to cover autism services for individuals through age 21. State employee plans also have to comply with this section (although that is not listed in this section). For children at birth through age 6 plans must cover an annual maximum of $50,000. For children age 7 through 21, the annual maximum is $12,000.
Copayments, coinsurance, and deductibles must be “no less favorable” than those in place for other medical services.
Insurance plans can review a child’s treatment plan once every 12 months.
Treatment for autism is defined as pharmacy care, psychiatric care, psychological care, therapeutic care, applied behavior analysis, habilitative care, and rehabilitative care.
This section requires individual plans and small employer fully-insured plans to cover pharmacy care, psychiatric care, psychological care, therapeutic care, applied behavior analysis, habilitative care, and rehabilitative care.
Plans are required to cover an annual maximum of $12,000.
This section provides definitions for many of the terms above (pharmacy care, psychiatric care, etc) and defines autism as any pervasive developmental disorders in the DSM, and specifically lists autistic disorder, asperger’s syndrome, and pervasive developmental disorder not otherwise specified.
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