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Legislation Signed into Law

2017-2018

Primary Focus: Mandated Benefit: Provider
Title/Description: Health Insurance Coverage for Autism Spectrum Disorders
Citation: Ohio Rev. Code Ann. § 3923.84
Summary: Individual and group sickness and accident insurance policies shall provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder. Benefits include:

(1) For speech and language therapy or occupational therapy for an insured under the age of fourteen;
(2) For clinical therapeutic intervention for an insured under the age of fourteen; and
(3) For mental or behavioral health outpatient services for an insured under the age of fourteen.

Ohio Rev. Code Ann. § 3923.84 states that such benefits may be limited to those that are preauthorized and ordered by a developmental pediatrician or a psychologist trained in autism.
Effective Date: April 6, 2017
Notes: Enacted through HB 463 (131st General Assembly)

Primary Focus: Mandated Benefit: Provider
Title/Description: Health Insurance Coverage for Autism Spectrum Disorders
Citation: Ohio Rev. Code Ann. § 1751.84
Summary: Individual and group health insuring corporation policy, contract, or agreement providing basic health care services shall provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder. Benefits include:

(1) For speech and language therapy or occupational therapy for an insured under the age of fourteen;
(2) For clinical therapeutic intervention for an insured under the age of fourteen; and
(3) For mental or behavioral health outpatient services for an insured under the age of fourteen.

Ohio Rev. Code Ann. § 1751.84 states that such benefits may be limited to those that are preauthorized and ordered by a developmental pediatrician or a psychologist trained in autism.
Effective Date: April 6, 2017
Notes: Enacted through HB 463 (131st General Assembly)

2015-2016

Primary Focus: Mandated Benefit: Provider
Title/Description: Home Visits and Cognitive Behavioral Therapy
Citation: Ohio Rev. Code Ann. § 5167.16
Summary: A Medicaid managed care organization shall provide cognitive behavioral therapy, provided by a community mental health services provider, to a Medicaid recipient who meets certain qualifications. Medicaid recipients who qualify may receive other related services, as well.
Ohio Rev. Code Ann. § 5167.16 continues on to discuss the qualification requirements.
Effective Date: September 29, 2015
Notes: Enacted through HB 64 (131st General Assembly)

2013-2014

HB 232
Introduced: 7/2013
Sponsor: Reps. Sears and Milkovich
Status: Signed into law 4/2014
Summary: Among many other things, this bill changed the sections of the state insurance law about parity so that nurse practitioners and marriage and family therapists are accepted providers for reimbursement of behavioral health services.

2011-2012

HB 153
Introduced: 3/2011
Sponsor: Reps. Amstutz
Status: Signed into law 6/2011
Summary: Among many other things, this bill prohibits the use of prior authorization for antidepressants and antipsychotics by Medicaid.

Ohio Parity Law

There are several sections of the state insurance law about parity. Some of these sections are only about coverage for mental health conditions, and there is another section that is about coverage for treatment of alcoholism.

Mental Health Conditions

This section and this identical section require individual plans, small employer fully-insured plans, large employer fully-insured plans, and self-insured plans (not exempted from state jurisdiction by ERISA ) to cover services for the following mental health conditions (as defined in the most recent version of the DSM ):

  • Schizophrenia
  • Schizoaffective disorder
  • Major depressive disorder
  • Bipolar disorder
  • Paranoia and other psychotic disorders
  • Obsessive-compulsive disorder
  • Panic disorder

Coverage for these conditions must be “on the same terms and conditions” and “no less extensive” than coverage for other medical conditions. The section clarifies that this applies specifically (but not only) to inpatient care, outpatient care, medication, deductibles, copayments, lifetime limits, and lifetime maximums.

The section clarifies that plans are allowed to use non-quantitative treatment limitations (NQTLs) and does not state that the use of NQTLs has to be the same as what is in place for other medical conditions.

Plans are allowed to file for an exemption from this section of the law if they can prove that complying with this section of the law for 6 months caused cost increases of at least 1%.

For any other mental health condition not listed above, this section requires plans to offer optional coverage that includes a $550 annual maximum for outpatient care and nothing else.

Alcoholism Coverage

This section requires small employer fully-insured plans and large employer fully-insured plans to offer optional coverage “alcoholism” but not any other substance use disorder.

If the optional coverage is chosen, plans must cover up to $550 per year for inpatient care, outpatient care, partial hospitalization, and residential treatment. Plans may use utilization review every 3 months to determine if treatment is medically necessary.

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Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

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