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.
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 The bill also repealed a section that had included a formula to determine which plans must comply with this section of the law.
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:
83-9-41 (“mental illness benefits”)
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 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.
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.
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).
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)
Insurance plans are only allowed to review a child’s treatment plans once every 6 months.
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