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This page lists some of the action toward parity compliance undertaken by Montana 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

4/2018

Primary Focus: Parity, Compliance
Agency: Office of the Montana State Auditor, Commissioner of Securities and Insurance
Title/Description: 2019 Requirements Health Plan Form and Rate Filings Including Qualified Health Plan Certification
Citation: Montana Insurance Notices and Bulletins April 2, 2018
Summary:  The bulletin provides instructions for on and off-exchange health plans. These instructions, including the timeline, apply to individual and small employer group health insurance. The Commissioner of Securities and Insurance is the primary regulator for all health insurance products sold in Montana. Policies may not exclude the services of specific types of providers that are acting within the scope of their license and providing a service that is a covered benefit, including, but not limited to, licensed marriage and family therapists and licensed addiction counselors. This practice may violate section 2706 of the ACA, as well as Mont. Code Ann. 33-22-111 and 33-30-1019. Broad exclusions for “family therapy,” “play therapy” and “group therapy” may be disapproved. Those services must be reviewed under medical necessity requirements that respect the parameters of the Mental Health Parity and Addiction Equity Act.
Effective Date: April 2, 2018
Notes: N/A

12/2016

The Montana Commissioner of Securities and Insurance released a bulletin (pdf | Get Adobe® Reader®) on mental health parity, focusing on non-quantitative treatment limitations. The memorandum contains a examples of “red flags” that indicate a potential parity violation. All of the “red flags” are taken from de-identified consumer complaints to the department. Examples include the following:

  • All outpatient mental health therapy must be justified with a new treatment plan every 90 days
  • All in-patient stays for mental illness or substance use disorder must be reauthorized every 5 days
  • No out-of-state treatment options for mental illness or substance use disorders
  • Inadequate network of mental health providers
  • Denial of claims or refusal of prior authorization for mental health treatment
  • Refusal to continue payment for outpatient therapy because progress has not been “proven” by the provider
  • Refusal to pay for therapy relating to a co-occurring mental illness while a member is receiving treatment for a substance use disorder
  • Refusal to pay for higher cost therapies until patient fails at a lower cost treatment
  • Exclusion of coverage for certain types of treatment without any medical necessity analysis

03/2016

The Montana Commissioner of Securities and Insurance released a bulletin (pdf | Get Adobe® Reader®) on 2017 requirements for health plan form filing. Among other things, the document contains a section on exclusions relating to transgendered individuals. The document clarifies that all exclusions relating to transgendered individuals must be removed. This is partly because of a Montana statute that prohibits discrimination against individuals in the same class. According to this statute, transgendered individuals are considered in the same class as non-transgendered individuals who may have a mental health condition.

10/2015

Christina Goe, General Counsel to the Montana Commissioner of Securities and Insurance, presented on the Montana Medicaid Expansion. The presentation had three slides on parity. The slides contain information on consumer protections under the Federal Parity Law. This presentation is similar to Goe’s 11/2014 presentation.

11/2014

Christina Goe, General Counsel to the Montana Commissioner of Securities and Insurance, presented on the Montana Medicaid Expansion. The presentation had three slides on parity. The slides contain information on consumer protections under the Federal Parity Law. This presentation is similar to Goe’s 10/2014 presentation.

9/2013

Christina Goe, General Counsel to the Montana Commissioner of Securities and Insurance, presented on health care reform in Montana. The presentation has two slides on the Federal Parity Law. The first slides states that health insurers can not apply financial requirements and treatment limitations in a more restrictive manner for mental health/substance use disorder benefits than physical health benefits. The second slide defines which plans must comply with the Federal Parity Law.

4/2010

The Montana Commissioner of Securities and Insurance took action against Assurant Health in Montana. Among other things, the company was not offering coverage for “severe mental illness” as is required by Montana’s insurance law. Assurant Health agreed to pay $39,569.76 in unpaid claims and to pay a $225,000 fine.

8/2009

The Montana Commissioner of Securities and Insurance issued a bulletin (pdf | Get Adobe® Reader®) notifying insurance plans about the requirements of the section of state law about autism coverage. The bulletin went into specific detail about what treatments must be covered, the annual maximums in place, the language in the law about financial requirements, that the law does apply to several types of plans beyond large employer fully-insured plans and small employer fully-insured plans, and that coverage for individuals with autism older than age 18 should be “no less favorable” than coverage for other medical conditions.

1/2008

Primary Focus: Access to Services
Agency: Public Health and Human Services
Title/Description: Cost Sharing Provisions
 Citation: ARM 37.79.501
Summary:  Outlines co-pays for Healthy Montana Kids enrollees when parents/guardians meet family income requirements.  Co-pays for behavioral health services are less than or equal to physical health services.
Effective Date: January 18, 2008
Notes: Montana Administrative Register Notice 37-415 (2008), Montana Administrative Register Notice 37-622 (2012), Montana Administrative Register Notice 37-639 (2013)

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 health coverage 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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