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Legislation Signed into Law

2018

Primary Focus: Medicaid
Title/Description: Medicaid-covered specialty services and supports; management and delivery; specialty prepaid health plans
Citation: Michigan Compiled Laws § 400.109f
Summary: The state department shall support the use of Medicaid funds for specialty services and supports for Medicaid beneficiaries with a serious mental illness, developmental disability, serious emotional disturbance, or substance use disorder.
Effective Date: March 20, 2018
Notes: Enacted through SB 649 (Regular Session 2017)

2016

Primary Focus: Disability Insurance
Title/Description: Diagnosis and treatment of autism spectrum disorders; coverage; prohibition; availability of other benefits; conditions; qualified health plan offered through American health benefit exchange pursuant to federal law; short-term or 1-time limited duration policy or certificate; prescription drug plan; coordinated benefits; definitions
Citation: Michigan Compiled Laws § 500.3406s
Summary: This statute requires an insurer that delivers a health insurance policy shall provide coverage for the diagnosis of autism spectrum disorders and treatment of autism spectrum disorders. Insurers are prohibited from terminating or refusing to provide coverage solely based on an individual’s diagnosis with autism spectrum disorder. Insurers cannot limit the number of visits used for treatment of autism spectrum disorders, or deny or limit coverage because the treatment is educational or habilitative in nature. An insurer may limit coverage for treatment of autism spectrum disorders to an insured enrollee through 18 years old and may apply a maximum annual benefit amount. Insurers may apply certain coverage conditions to treatment for an autism spectrum disorder.
Effective Date: July 1, 2016
Notes: Enacted through HB 4935 (Regular Session 2016)

Primary Focus: Mandated Benefit: substance use disorders
Title/Description: Health insurance policies; coverage for intermediate and outpatient care for substance abuse disorder required; charges, terms and conditions; reduction of coverage; deductibles and copayment provisions; definitions
Citation: Michigan Compiled Laws § 500.3425
Summary: An insurer that delivers a health insurance policy shall provide coverage for intermediate and outpatient care for substance use disorder. The charges, terms, and conditions for coverage of such services shall not be less favorable than the maximum prescribed for other comparable services. The insurer shall not reduce coverage required for such services by terms or conditions applicable to other items of coverage in the policy.
Effective Date: July 1, 2016
Notes: Enacted through HB 4935 (Regular Session 2016)

2011-2012

SB 414/SB 415
Introduced: 6/2011
Sponsor: Sen. Green and Sen. Hunter
Status: Signed into law 4/2012
Summary: This bill added the section to the state insurance law about autism coverage (that section is summarized at the bottom of this page under “Michigan Parity Law,” “Autism Coverage”)

Primary Focus: Mandated Benefit: Provider
Title/Description: Diagnosis and treatment of autism spectrum disorders; coverage; prohibition; availability of other benefits; conditions; qualified health plan offered through American health benefit exchange pursuant to federal law; prescription drug plan; coordinated benefits; definitions
Citation: Michigan Compiled Laws § 550.1416e
Summary: A health care corporation group or nongroup certificate shall provide coverage for the diagnosis of autism spectrum disorders and treatment of autism spectrum disorders. Insurers cannot limit the number of visits used for treatment of autism spectrum disorders, or deny or limit coverage because the treatment is educational or habilitative in nature. An insurer may limit coverage for treatment of autism spectrum disorders to an insured enrollee through 18 years old and may apply a maximum annual benefit amount. Insurers may apply certain coverage conditions to treatment for an autism spectrum disorder.
Effective Date: April 18, 2012
Notes: Enacted through SB 414 (2011 Regular Session)

Michigan Parity Law

There are two sections of the state insurance law relevant to parity. One is about substance use disorder coverage and the other is about autism coverage.

Substance Use Disorder Coverage

This section requires individual plans, small employer fully-insured plans, to cover substance use disorder services.

Plans must cover at least $1,500 per year for outpatient care and intermediate levels of care (this amount can be adjusted for inflation and has been since this law was written; currently it is over $4,000).

Autism Coverage

This section requires individual plans, small employer fully-insured plans, and large employer fully-insured plans to cover autism services through age 18.

It requires plans to cover an annual maximum of at least $50,000 through age 6, at least $40,000 from 7 through 12, and at least $30,000 from 13 through 18. Financial requirements for autism services must be the same as those in place for other medical services and there cannot be a limit on outpatient visits for autism treatment.

Plans may request that an autism diagnostic observation schedule (this term is defined in the law) be performed on a child once every three years, and plans may review a child’s treatment plan once a year.

Any individual plans or small employer fully-insured plan offered on the exchange under the Affordable Care Act does not have to cover anything in this section that goes beyond what is required of them from covering essential health benefits.

Autism spectrum disorders are defined as autistic disorder, Asperger’s syndrome, and pervasive developmental disorder not otherwise specified.

Treatment of autism spectrum disorder is listed as (all of these are defined in the law):

Get Support

Michigan 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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