Mississippi

There are several sections in the state insurance law about relevant to parity and another section about autism coverage. The sections about parity will be summarized under “Behavioral Health Coverage,” and the autism section will be summarized under “Autism Coverage.”

There are several relevant sections:

• 83-9-37 (“definitions”)
• 83-9-39 (“coverage”)
• 83-9-41 (“mental illness benefits”)
• 83-9-43 (“non-discrimination”)

Note: It is not possible to link directly to these sections. To find them, click here and then click on the plus sign (+) next to “Title 83. Insurance”. Then click on the plus sign (+) next to “Chapter 9”. Then click on the plus sign (+) next to “Coverage for Treatment of Mental Illness”. Then you can click on any of the sections that are listed above.

These sections require large employer fully-insured plans to cover services for behavioral health conditions. Individual plans and small employer fully-insured plans must offer optional coverage for behavioral health services. However, this optional coverage must follow the same standards as the mandatory coverage required of large employer fully-insured plans.

These sections require this coverage for “mental illness”, which is defined as any “psychiatric disease” in the “current edition” of either the ICD or the DSM. That means this definition should be interpreted to include substance use disorders.

Plans are required to cover at least 30 days of inpatient care, 60 days of partial hospitalization, and 52 visit of outpatient care. The law states that the “rate of payment” for these services must be the same as for other medical services.

Financial requirements, annual maximums, and lifetime maximums for behavioral health services must be “no less favorable” than those in place for other medical services.

This section (pdf | Get Adobe® Reader®) takes effect on January 1, 2016. The link provided is to the legislation that became law. It is the first section of this bill. The rest of the bill is about licensing for behavior analysts.

This section requires large employer fully-insured plans, some individual plans, state and other public employee plans to cover autism services. It explicitly does NOT apply to small employer fully-insured plans and individual plans that are required to cover essential health benefits by the Affordable Care Act. Coverage for small employer fully-insured plans not required to cover essential health benefits is optional.

Plans must cover 25 hours per week of applied behavior analysis through age 8. Coverage may be required beyond age 8 if it is determined to be medically necessary. Only 10 hours per week is required for licensed behavior analysts, but all services must be monitored by a licensed behavior analyst (this means that non-licensed professionals are allowed to provide autism services as long as they have a supervisor who is a licensed behavior analyst).

Financial requirements for autism services must be equal to those used for other medical services.

Autism spectrum disorder is defined as “any of the pervasive developmental disorders or autism spectrum disorders as defined by the most recent edition of the DSM or the edition that was in effect at the time of diagnosis.”

Treatment for autism is listed as (these terms are defined in greater detail in the law):

• Behavioral health treatment (includes applied behavior analysis)
• Pharmacy care
• Psychiatric care
• Psychological care
• Therapeutic care

Insurance plans are only allowed to review a child’s treatment plans once every 6 months.