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Legislation Signed into Law

2019

Primary Focus: Mandated Benefit: Peer Support
Title/Description: Peer Support Specialist Medicaid Coverage
Citation: MCA §53-6-101
Summary: Amends MCA §53-6-101 to make services provided by behavioral health peer support specialists eligible for Medicaid coverage.
Effective Date: 7/1/2019
Notes: Enacted through S30

2017

Primary Focus: Access to Services
Title/Description: Coverage for services provided under freedom of choice for mental health services.
Citation: 33-30-1020, MCA
Summary: Group and individual insurance contracts shall provide coverage for health services provided by marriage and family therapists.
Effective Date: January 1, 2019
Notes: Enacted by Mt. HB 469.

Primary Focus: Access to Services
Title/Description: Policies and certificates to provide for freedom of choice of practitioners — professional practice not enlarged.
Citation: 33-22-111, MCA
Summary: All policies or certificates of disability insurance, including individual, group, and blanket policies or certificates, must provide that the insured has full freedom of choice in the selection of any psychologist, licensed social worker, licensed professional counselor, licensed addiction counselor, licensed marriage and family therapist for treatment of any illness or injury within the scope and limitations of the person’s practice.
Effective Date: January 1, 2019
Notes: Amended by Mt. HB 469.

HB 142
Introduced: 01/2017
Sponsor: Rep. Bishop
Status: Signed Into Law 5/2017
Summary: Among other things, this bill changed the sections of the state’s insurance law related to behavioral health coverage:

  • It specifies that individual plans, small-group plans, and large-group plans should provide coverage for mental health conditions and substance use disorders in a way that is “no less favorable” than coverage for other medical conditions
  • It defines “no less favorable” as being what is specified in the Federal Parity Law and its final regulations on January 1, 2017, thereby maintaining parity protection in the individual and small-group market no matter what happens with efforts to amend the Affordable Care Act
  • It repeals the standalone section specifying certain coverage levels for serious mental illness and incorporates those conditions into the section regarding other mental illness and substance use disorders
  • It eliminates multiple restrictive annual and lifetime maximums alongs with limits on inpatient days and partial hospitalization

2013

Primary Focus: Access to Services
Title/Description: Coverage for telemedicine services.
Citation: 33-22-138, MCA
Summary: Each group or individual policy, certificate of disability insurance, subscriber contract, membership contract, or health care services agreement that provides coverage for health care services must provide coverage for health care services provided by a health care provider or health care facility by means of telemedicine if the services are otherwise covered by the policy, certificate, contract, or agreement, including mental health centers.
Effective Date: April 5, 2013.
Notes: Amended by Mt. SB 270.

2009

SB 234
Sponsor: Sen. Gillan
Status: Signed Into Law 4/2009
Summary: Among other things, this bill added the autism section to the state’s insurance law. This section of the law is summarized at the bottom of this page.

Montana Parity Law

The sections of Montana law that are relevant to parity are found in the state’s insurance law. There is one section for behavioral healthcoverage and another section for autism coverage.

Behavioral Health

This section of the law has a subsection for “severe mental illness” and a several subsections for other mental health conditions and substance use disorders.

Severe mental illness is defined by the subsection as:

  • Schizophrenia
  • Schizoaffective disorder
  • Bipolar disorder
  • Major depression
  • Panic disorder
  • Obsessive compulsive disorder
  • Autism (this section indicates that plans must comply with the autism section of the law)

This subsection requires large employer fully-insured plans, small employer fully-insured plans, and individual plans to cover services for these conditions in a way that is “no less favorable” than coverage for other medical services. It states that this coverage should include, but not be limited to, inpatient care, outpatient care, rehabilitative services, and medication.

The subsections of the law about other behavioral health conditions require large employer fully-insured plans and small employer fully-insured plans to cover the following:

  • 21 days of inpatient care for mental health conditions
  • 1 inpatient day can be traded for 2 days of partial hospitalization
  • $2,000 annual maximum for outpatient care for mental health conditions
  • $6,000 annual maximum for substance use disorder treatment
  • $12,000 lifetime maximum for substance use disorder treatment (annual maximum is reduced to $2,000 when the lifetime maximum is met)

This subsection specifically excludes eating disorders besides anorexia and bulimia, developmental disorders, speech disorders, and impulse control disorders besides intermittent explosive disorder and trichotillomania.

Autism

This section requires large employer fully-insured plans, small employer fully-insured plans, and state or local government employee plans to cover autism services through age 18. It defines autism spectrum disorder as:

  • Autistic disorder
  • Asperger’s disorder
  • Pervasive developmental disorder not otherwise specified

It lists treatment of autism as:

  • Medications (pharmacy care)
  • Psychological care
  • Psychiatric care
  • Habilitative and rehabilitative care (includes applied behavior analysis )

All of these forms of care are further defined in this section of the law.

It requires plans cover an annual maximum of $50,000 age 8 and younger and an annual maximum of $20,000 for children age 9 through 18.

It states that copayments, coinsurance, and deductibles that do not apply to other medical services cannot be used for autism services.

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

Get Support

Montana 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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