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

10/2017

Primary Focus: Medicaid
Agency: Department of Health and Human Services
Title/Description: The Physical Health Managed Care Basic Benefits Package: Section 4-003.01: General Requirements
Citation: 482 Neb. Admin. Code § 4-001
Summary: The health plan is required to comply with all applicable state and federal regulations, such as the prohibition against assisted suicide; inappropriate use of funds/profits, lack of mental health parity, and the noncompliance with the provisions of the Hyde Amendment.
Effective Date: The new rule was effective October 16, 2017 and expires on October 24, 2024.
Notes: N/A

2/2017

Primary Focus: Insurance
Agency: Nebraska Department of Insurance
Title/Description: Nebraska Insurance Notices and Bulletins
Summary: The bulletin discussed insurer obligations in complying with parity requirements stating:
“Insured large group plans, insured small group, individual market plans and student health plan forms are being reviewed for compliance with the regulations of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

The division is reviewing insured large group plans, insured small group, individual market plans and student health plan forms for compliance with the regulations of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

The Department’s review will include filed policies, certificates, and schedules.

Objections will be made to any plan design that imposes a financial requirement or quantitative treatment limitation applicable to mental health or substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or quantitative treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification.”

Issued Date: February 24, 2017
Notes: N/A

2/2016

The NDOI required all non-grandfathered individual and small employer fully-insured plans to complete this checklist (pdf | Get Adobe® Reader®). To demonstrate compliance with the Affordable Care Act and state insurance law. One of the boxes explained that these plans had to comply with the Federal Parity Law and the parity section of the state insurance law (found at the top of page 3; the parity sections of the state insurance law are summarized at the bottom of this page). The NDOI required plans to complete this checklist in prior years as well (links to those documents are no longer functional).

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:

These sections of the law do not require any plans to cover mental health services, but have requirements if plans do provide coverage. Theses sections apply to large employer fully-insured plans and small employer fully-insured plans, except for those with 15 employees or less. The law only applies to coverage for these conditions:

  • Schizophrenia
  • Schizo-affective disorder
  • Delusional disorder
  • Bipolar disorder
  • Major depression
  • Obsessive compulsive disorder

If plans cover services for these conditions they cannot have different annual maximums or lifetime maximums than those in place for other medical services. Limits for outpatient care and inpatient care must be the same as well.

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 make clear that they do not apply to substance use disorder services.

Alcoholism Coverage

The section of the law about “alcoholism coverage” is actual several small sections:

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.

Autism Coverage

This section of the law requires large employer fully-insured plans, small employer fully-insured plans, individual plans, and any self-insured plans that are not exempted by federal law (mostly state and local government self-insured plans) to cover autism services for individuals through age 20. However, this section explicitly does not apply to non-grandfathered small employer fully-insured plans and individual plans that are required to cover essential health benefits under the Affordable Care Act.

Plans must cover 25 hours per week of “behavioral health treatment” (applied behavior analysis ) and cannot subject any other form of autism treatment to any sort of annual maximum, lifetime maximum, annual limit, or lifetime limit.

Plans must use the same financial requirements for autism services as are in place for other medical services.

An insurance plan can only review a child’s treatment plan once every 6 months.

The following are considered legitimate treatments for autism:

Get Support

Nebraska 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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