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

12/2017

Primary Focus: Parity: General
Agency: The Department of Health
Title/Description: Mental Health Parity and Addiction Equity Act Compliance Plan
Citation: The report is available here.
Summary: Mental Health Parity and Addiction Equity Act Compliance Plan: Louisiana Parity Analysis report prepared by the Louisiana Department of Health; Office of Behavioral Health.
Release Date: December 2, 2017
Notes: N/A

5/2016

Primary Focus: Parity: General
Agency: The Department of Health and Hospitals, Bureau of Health Services Financing
Title/Description: Benefits and Services
Citation: LAC 50:I.10103, as created by LR 42:756
Summary: Minimum Essential Health Benefits. Pursuant to § 1302(b) of ACA, the ABP must provide the new adult group with a benchmark benefit or benchmark-equivalent benefit package that includes the required minimum essential health benefits (EHBs) provided in affordable insurance exchanges. There are 10 benefit categories and some of the categories include more than one type of benefit. The following services are considered EHBs:

  1. mental health and substance use disorder services, including behavioral health treatment:
  2. these services shall be in accordance with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008;

Effective Date: May 20, 2016
Notes: N/A

12/2013

The Louisiana Department of Insurance (LDI) issued a bulletin to plans clarifying the requirements and conditions for plans that were applying for temporary exemption from the Affordable Care Act (transitional relief [pdf | Get Adobe® Reader®]). Among many other things, it clarified that among any plans that qualified for this exemption, individual plans would still have to comply with the Federal Parity Law while small employer fully-insured plans would not (top of page 3).

4/2013

The Louisiana Department of Insurance (LDI) issued a bulletin (pdf | Get Adobe® Reader®) about the Department’s authority to enforce the Federal Parity Law and the Affordable Care Act (ACA). Pages 1 through 3 are relevant to parity. It informed plans that LDI would be monitoring all relevant plans for compliance with the Federal Parity Law and the ACA. Any plans that were found non-compliant would be issued a notice of non-compliance and asked to change their policies so that they abide by these federal laws. If there was continued non-compliance, LDI would refer any plan to the Center for Medicare and Medicaid Services (CMS) for further disciplinary action.

The bulletin also stated that LDI would respond to and investigate any consumer complaints related to the Federal Parity Law and the ACA. The LDI would request that any plan that was violating these laws should adjust their actions to resolve the issue. Any plan that “refuses to take corrective action” would be referred to CMS for further action. If any complaints or investigations reveal a pattern of violations, LDI and CMS would discuss the possibility of performing market conduct examinations. The bulletin also declared that LDI would assess any plan’s compliance with the Federal Parity Law and the ACA whenever LDI performs a market conduct examination.

Pages 4 through 10 contained information relevant to the ACA, but not relevant to parity.

Louisiana Parity Law

There are several sections of the state insurance law relevant to parity. They will be summarized below in this order (with appropriate hyperlinks to state law):

Mental Health Coverage

This section requires large employer fully-insured plans, small employer fully-insured plans, other group plans, and self-insured plans (except those exempted by ERISA ) to cover the following mental health conditions:

  • Schizophrenia or schizoaffective disorder
  • Bipolar disorder
  • Panic disorder
  • Obsessive-compulsive disorder
  • Major depressive disorder
  • Anorexia/bulimia
  • Intermittent explosive disorder
  • Posttraumatic stress disorder
  • Psychosis not otherwise specified in children under seventeen years of age.
  • Rett’s Disorder
  • Tourette’s Disorder

This coverage must be “under the same circumstances and conditions or greater” as coverage for other medical conditions. Plans must cover at least:

Enrollees can exchange each day of inpatient care for 4 outpatient visits or 2 days of residential treatment or partial hospitalization.

This section requires only large employer fully-insured plans to do the following regarding annual maximums and lifetime maximums:

Plans cannot use annual maximums and lifetime maximums for mental health services if they aren’t in place for other medical services. If a plan does have these in place for other medical services, they can do either of the following:

  • Make it so that both behavioral health services and other medical services count towards combined maximums OR
  • Make the maximums for mental health services no less than the ones in place for other medical services

For plans that have many different maximums for different categories of medical care, the law requires plans to use a mathematical formula involving the weighted averages these annual and lifetime maximums to decide what the limits and maximums should be for mental health services.

Plans are exempt from this section if complying with it causes premium costs to increase by 1% in any year.

Substance Use Disorders

This section requires large employer fully-insured plans and small employer fully-insured plans to offer optional coverage for substance use disorders that includes inpatient care, outpatient care, and residential treatment. However, this section does not specify anything further about how extensive this coverage should be.

Autism

This section requires large employer fully-insured plans and small employer fully-insured plans to cover autism services for individuals through age 20.

Plans must cover an annual maximum of $36,000.

Copayments, coinsurance, and deductibles must be “no less favorable” than those in place for other medical services.

There cannot be any visit limits for outpatient care.

There is no restriction on how often plans can review a child’s treatment plan.

Treatment for autism is defined as pharmacy care, psychiatric care, psychological care, therapeutic care, applied behavior analysis, habilitative care, and rehabilitative care.

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Louisiana 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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