Primary Focus: Mandated Benefit; Provider; Parity Title/Description: General Program Description for Managed Care Organizations Agency: New Mexico Human Services Department Citation: N.M. Code R. § 8.308.9.11(E) Summary: Managed Care Organizations shall meet all behavioral health parity requirements as set forth in CFR 42, Chapter IV, subchapter C, 438.905 – Parity requirements. Effective Date: May 1, 2018 Notes: 8.308.9.11 NMAC – Rp, 8.308.9.11 NMAC, 5/1/2018
Primary Focus Mandated Benefit; Provider Title/Description: Behavioral Health Services for Managed Care Organizations Agency: New Mexico Human Services Department Citation: N.M. Code R. § 8.308.9.19 Summary: MCOs must cover the enumerated behavioral health services. Some services include applied behavior analysis, crises services, and comprehensive community support services. Effective Date: May 1, 2018 Notes: 8.308.9.19 NMAC – Rp, 8.308.9.19 NMAC, 5/1/2018
The bulletin goes on to explain that although this part of the ACA does not apply to large employer fully-insured plans, the Federal Parity Law does, which means the annual maximums and lifetime maximums in the state law cannot be used for autism services if they are not used for other medical services.
The bulletin also asks the Legislature to change the section about autism coverage in the state insurance law so that it references the DSM V, not the DSM IV.
New Mexico’s OSI issued a bulletin,(pdf | Get Adobe® Reader®) but withdrew it three days later. There were two sentences in the bulletin about the Federal Parity Law. It stated that plans have to cover behavioral health services “at parity with other medical conditions” if those services are offered.
New Mexico Parity Law
There are multiple sections in New Mexico law that are relevant to parity and autism coverage.
Please be aware that it is not possible to provide direct links to any of the following sections of the law. To find these sections, go to this link and click on the plus sign next to the folder in the upper left side of the screen that says “statutes, rules, const.” Then click on the plus sign next to the folder that says NMSA (unannotated). Then, underneath chapter 24, click on the plus sign next to the “more” folder. Then, click on “Chapter 59A Insurance Code.”
To find all of the sections listed below, click on the appropriate article once you are on the “Chapter 59A” page and then the appropriate section on the article pages. For example, to find the mental health parity section, click on article “23E Health Insurance Portability,” and then click on section “59A-23E-18 Requirements for Mental Health Benefits…”
Autism spectrum disorder is defined as anything in the DSM including autistic disorder, Asperger’s disorder, pervasive developmental disorder not otherwise specified, Rett’s disorder, and childhood disintegrative disorder.
Treatment of autism spectrum disorder is defined as speech therapy, occupational therapy, physical therapy and applied behavioral analysis .
Plans do not have to cover any services in Part B of the Individuals with Disabilities Education Improvement Act (IDEA). Plans are not exempted from Part C, however. Part B is for individuals age 3 through age 21. Part C is for children at birth through age 2.
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