Primary Focus: Mandated Benefits Title/Description: Coverage for screening, diagnosis, and treatment of autism spectrum disorder Citation: R.R.S. Neb. § 44-7,106 Summary: Generally speaking, insurance plans must provide coverage for the screening, diagnosis, and treatment of an autism spectrum disorder in an individual under twenty-one years of age. No insurer shall terminate coverage or refuse to deliver, issue for delivery, amend, or renew coverage of the insured as a result of an autism spectrum disorder diagnosis or treatment.
Coverage for an autism spectrum disorder shall not be subject to any limits on the number of visits an individual may make for treatment of an autism spectrum disorder, nor shall such coverage be subject to dollar limits, deductibles, copayments, or coinsurance provisions that are less favorable to an insured than the equivalent provisions that apply to a general physical illness under the policy.
However, coverage for behavioral health treatment, including applied behavior analysis, shall be subject to a maximum benefit of twenty-five hours per week until the insured reaches twenty-one years of age. Payments made by an insurer on behalf of a covered individual for treatment other than behavioral health treatment, including applied behavior analysis, shall not be applied to any maximum benefit established under this section. Effective Date: July 18, 2014 Notes: This does not apply to non-grandfathered plans in the individual and small group markets that are required to include essential health benefits under the federal Patient Protection and Affordable Care Act or to medicare supplement, accident-only, specified disease, hospital indemnity, disability income, long-term care, or other limited benefit hospital insurance policies. Enacted by LB 254 (103rd Legislature)
Primary Focus: Mandated Benefits Title/Description: Medical assistance; mandated and optional coverage; department; submit state plan amendment or waiver. Citation: R.R.S. Neb. § 68-911 Summary: Medical assistance shall include coverage for health care and related services as required under Title XIX of the federal Social Security Act, including mental health and substance abuse services.
By July 1, 2009, he Department of Health and Human Services shall submit a state plan amendment or waiver to provide coverage under the medical assistance program for community-based secure residential and subacute behavioral health services for all eligible recipients, without regard to whether the recipient has been ordered by a mental health board under the Nebraska Mental Health Commitment Act to receive such services. Effective Date: July 1, 2009 Note: Enacted through LB 603 (101st Legislature) The 2013 amendment by LB 556 added (1)(m); re-designated former (1)(m) as (1)(n); added “which shall include both physical and behavioral health screening, diagnosis, and treatment services” in (1)(n); and made a related change.
Primary Focus: Parity – General, Mandated Benefits Title/Description: Mental health conditions; coverage; requirements. Citation: R.R.S. Neb. § 44-793 Summary: If a health insurance plan provides coverage for treatment of mental health conditions other than alcohol or substance abuse, (i) it must not establish any rate, term, or condition that places a greater financial burden on an insured for access to treatment for a serious mental illness than for access to treatment for a physical health condition and (ii) if an out-of-pocket limit is established for physical health conditions, the insurance plan must apply such out-of-pocket limit as a single comprehensive out-of-pocket limit for both physical health conditions and mental health conditions. If no coverage is to be provided for treatment of mental health conditions, the insurance plan must provide clear and prominent notice of such noncoverage. Effective Date: March 15, 2007 Notes: Amended by LB 296.
Nebraska Parity Law
There is a section of the state insurance law about parity for mental illness, another section about “coverage for treatment of alcoholism,” and another section about autism coverage.
Mental Health Coverage
The section about mental health coverage is actually several small sections of the state insurance law:
If a plan uses a deductible, there must be only one deductible for both mental health services and other medical services.
Plans are explicitly allowed to use non-quantitative treatment limitations for mental health services and there is no language stating that they must be used similarly to how they are for other medical services.
If a plan does not cover mental health services, it must “provide clear and prominent notice of such non-coverage.”
These sections of the law define “basic coverage for treatment of alcoholism” if it covers 30 days of inpatient care for alcoholism treatment in any given year and 60 outpatient visits over the life of a policy. However, this section of the law does not require plans to provide this coverage and explicitly states that plans can provide lesser coverage.
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