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Legislation Signed into Law

2015

Primary Focus: Mandate benefit; Provider
Title/Description: Screening, diagnosis and treatment of autism spectrum disorder.
Citation: Miss. Code Ann. § 83-9-26
Summary: A health insurance policy shall provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder. To the extent that the screening, diagnosis, and treatment of autism spectrum disorder are not already covered by a health insurance policy, coverage under this section will be included in health insurance policies that are delivered, executed, issued, amended, adjusted, or renewed in this state, or outside this state if insuring residents in Mississippi
Effective Date: July 1, 2015.
Notes: Enacted by 2015 Miss. H.B. 885.

2014

SB 2331
Introduced: 1/2014
Sponsor: Sen. Carmichael
Status: Signed into law 3/2014
Summary: This bill changed some of the sections of the state insurance law relevant to parity to what they are currently (these sections are summarized at the bottom of this page under “Mississippi Parity Law”). The specific changes this bill made were to include outpatient care as services that must have “the same rate of payment” as services for other medical care. The bill also repealed a section that had included a formula to determine which plans must comply with this section of the law.
HB 542
Introduced: 1/2014
Sponsor: Rep. Massengill
Status: Signed into law 3/2014
Summary: This bill ordered the State and School Employees Health Insurance Management Board to study the possibility of expanding autism coverage for state employee plans and public school employee plans. The Board was to present the results of this study to the Legislature and the Lieutenant Governor by 12/1/2014.

Mississippi Parity Law

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.”

Behavioral Health 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.

Autism Coverage

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.

Get Support

Mississippi 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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