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This page lists some of the action toward parity compliance undertaken by Michigan 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 Michigan Department of Insurance and Financial Services (DIFS) has a page on its website called “Health Coverage Basics.” Among other things, it lists some of the requirements of the section of the state insurance law about autism coverage and notes that coverage for autism may also be subject to the Federal Parity Law and the Affordable Care Act. This page also explains that mental health and substance use disorder coverage is an essential health benefit.

6/2018

Primary Focus: Access to Services
Agency: Michigan Department of Health and Human Services
Title/Description: Civil Rights
Citation: Mich. Admin. Code R 330.7009 (2018)
Summary: This administrative code lists the basic civil rights of recipients of mental health services related to provision of services.
Effective Date: June 1, 2018
Notes: N/A

Primary Focus: Access to Services
Agency: Michigan Department of Licensing and Regulatory Affairs
Title/Description: Recipient Rights Generally
Citation: Mich. Admin. Code R 325.14304 (2018)
Summary: This administrative code states that, with respect to recipients in a substance abuse disorder program, the admission of a recipient to a treatment program or receipt of prevention services shall not result in the recipient being deprived of any rights, privileges, or benefits which are guaranteed to individuals by law.
Effective Date: June 1, 2018
Notes: N/A

5/2016

The Michigan DIFS’ website contains a frequently asked questions section on benchmark plans . One of the questions addresses if health insurers are required to offer autism benefits. The answer clarifies that applied behavior analysis is a mandated benefit for all health plans that must meet the essential health benefit requirements.

7/2015

The Michigan DIFS issued a bulletin (pdf | Get Adobe® Reader®) that adjusted the minimum annual maximum for substance use disorder services for certain insurance plans from 4/1/2015 to 3/31/2016 to $4,309. It listed the minimum annual maximum for the previous 3 years:

  • April 1, 2014 through March 31, 2015 —- $4,240
  • April 1, 2013 through March 31, 2014 — $4,179
  • April 1, 2012 through March 31, 2013 -— $4,094

The bulletin noted that it only applied to grandfathered plans and several other plans that are currently exempt from complying with all of the Affordable Care Act (ACA). It also specified that certain plans that had been exempt from the ACA that have a renewal date after 7/1/2014 must comply with the Federal Parity Law.

Note: The DIFS issues one of these bulletins every year but does not provide links to past bulletins on this topic.

1/2015

The Michigan DIFS released an executive report (pdf | Get Adobe® Reader®) that contained recommendations for Michigan’s 2017 essential health benefit benchmark plan. On page 9, the report contains a section on mental health parity . The sections clarifies that all benchmark plans must be in compliance with the Federal Parity Law . If a plan is in violation, DIFS will modify the plan so it is in compliance.

4/2014

The Michigan DIFS issued an order (pdf | Get Adobe® Reader®) to certain plans that were temporarily exempt from complying with some sections of the Affordable Care Act. Among other things, it reminded them that they still had to comply with the Federal Parity Law.

3/2014

The Michigan DIFS issued a bulletin (pdf | Get Adobe® Reader®) about Qualified Health Plans for 2015. Among other things, the bulletin noted that individual plans and small employer fully-insured plans that cover essential health benefits must comply with the Federal Parity Law. It also advised plans to review the final rule (pdf | Get Adobe® Reader®) of the Federal Parity Law to understand if the law applies to them and if they are in compliance.

11/2013

The Michigan DIFS issued an order (pdf | Get Adobe® Reader®) to certain plans that were temporarily exempt from complying with some sections of the Affordable Care Act. Among other things, it reminded them that they still had to comply with the Federal Parity Law.

1/2013

The Michigan DIFS issued an order (pdf | Get Adobe® Reader®) to individual plans and small employer fully-insured plans that must cover essential health benefits under the Affordable Care Act. It notified them that applied behavior analysis for autism treatment must be covered as an essential health benefit. It also notified these plans that they are not allowed to use any annual maximums or lifetime maximums for autism services. However, it informs them that they should convert any annual or lifetime maximums in their plans to non-quantitative treatment limitations that must be approved by DIFS. It advises large employer fully-insured plans to do the same regarding autism coverage.

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

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