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

The Ohio Department of Insurance (ODI) has a page on its website about parity. On this page is a link to a frequently asked questions page about parity. There is also a link to a chart (pdf | Get Adobe® Reader®) that lists different kinds of insurance plans and whether the Federal Parity Law applies to them and which parity sections of the state insurance law apply. It also includes a hotline for the Consumer Services Division within ODI.

These pages contain very useful information that address many questions and concerns consumers may have about parity. Unfortunately, some of the information is out-of-date. It links to the 2010 Interim Final Rule issued for the Federal Parity law instead of the Final Rule, (pdf | Get Adobe® Reader®) released in 2013. It also does not mention that the Affordable Care Act applies the Federal Parity Law to many individual plans and small employer fully-insured plans thereby creating the false impression that none of these plans are covered by federal law.

ACA Form Filing Checklist

The ODI requires plans to fill out checklists to demonstrate that they comply with the Affordable Care Act and relevant sections of the state insurance law. Here is an example (pdf | Get Adobe® Reader®) of one of those checklists. One of the requirements is that plans demonstrate that they comply with the Federal Parity Law and parity sections of the state insurance law (page 8 and page 11).

5/2018

Primary Focus: Medicaid
Agency: Medicaid Services
Title/Description: Coverage and Limitations of Behavioral Health Services
Citation: Ohio Admin. Code 5160-27-02
Summary: Medicaid will reimburse behavioral health services, but that reimbursement is subject to several limitations, including ICD-10 coding, prior authorization requirements, medically necessary requirements, time spent with the patient/client, provider requirements, etc.
Effective Date: May 3, 2018
Notes: N/A

1/2018

Primary Focus: Medicaid
Agency: Medicaid Services
Title/Description: MyCare Ohio Plans: Covered Services
Citation: Ohio Admin. Code 5160-58-03
Summary: A MyCare Ohio plan must ensure members have access to all medically-necessary medical, drug, behavioral health, nursing facility and home and community-based services covered by Ohio Medicaid.
Effective Date: January 1, 2018
Notes: N/A

11/2017

Primary Focus: Medicaid
Agency: Medicaid Services
Title/Description: Healthchek: Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Covered Services
Citation: Ohio Admin. Code 5160-1-14
Summary: For Medicaid-eligible individuals younger than 21, Healthchek covers a comprehensive health and developmental history, including assessment of both physical and mental health development, as well as substance abuse disorders, as well as other screening services.
Effective Date: November 1, 2017
Notes: N/A

7/2017

Primary Focus: Medicaid
Agency: Medicaid Services
Title/Description: Services Authorized for Medicaid Coverage That Can Be Provided By Medicaid School Program (MSP) Providers
Citation: Ohio Admin. Code 5160-35-05
Summary: A Medicaid School Program provider may provide skilled services, and these services are authorized for Medicaid coverage, such as occupational therapy services, physical therapy services, speech-language pathology services, audiology services, nursing services, mental health services, and assessments and evaluations.
Effective Date: July 1, 2017
Notes: N/A

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.

Get Support

Common Violations

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

Common Violations

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