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Legislation Signed into Law

2015

SB 190
Introduced: 2/2015
Sponsor: Sens. Solano, Brown, and Rave and Reps. Munsterman, Cronin, Gosch, and Westra
Status: Signed into law 3/2015
Summary: Among other things, this bill added the section to the state insurance law about autism coverage. That section is summarized at the bottom of this page under “South Dakota Parity Law.”

2014

SB 108
Introduced: 1/2014
Sponsor: Sen. Rave and Rep. Cronin
Status: 3/2014
Summary: This bill ordered the state Department of Human Services and the state Department of Labor and Regulation (responsible for insurance regulation) to perform a study about autism services and insurance coverage for autism services, including associated costs. The departments were to report their findings to the Governor and the Legislature by November of 2014.

South Dakota Parity Law

There are several sections of the law addressing behavioral health coverage and autism coverage:

Mental Health Coverage

Individual plans, small employer fully-insured plans, and large employer fully-insured plans are required to cover services for the following conditions:

  • Schizophrenia and other psychotic disorders
  • Bipolar disorder
  • Major depression
  • Obsessive compulsive disorder

This coverage must have the same annual maximums, lifetime maximums, deductibles, coinsurance, and “restrictions” as what are in place for other medical services.

Substance Use Disorder Coverage

Individual plans, small employer fully-insured plans, and large employer fully-insured plans are required to offer optional coverage for “treatment of alcoholism”. If a plan enrollee chooses a plan with this coverage, the plan must cover at least 30 days of inpatient care during any 6-month time period and have a lifetime limit of at least 90 days of inpatient care.

There is also a condition in the state insurance law forbidding insurance plans from excluding coverage of injuries sustained while a person was under the influence of drugs and alcohol. For example, a plan may not refuse to cover treatment for a broken arm because the person was under the influence of drugs or alcohol when the injury occurred. However, plans can exclude coverage for any “sickness or injury caused in the commission of a felony.”

Autism Coverage

Large employer fully-insured plans, self-insured non-federal governmental plans (except for South Dakota’s state employee plan), some individual plans, and some small employer fully-insured plans are required to cover applied behavior analysis as follows:

  • $36,000 annual maximum through age 6
  • $25,000 annual maximum for age 7 through age 13
  • $12,000 annual maximum age 14 through age 18

Individual plans and small employer fully-insured plans that provide essential health benefits under the Affordable Care Act do not have to comply with this section of the insurance law.

Autism spectrum disorder is defined as “a complex neurodevelopmental medical disorder characterized by social impairment, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior.” There is no mention of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or any other officially recognized diagnostic guide.

Treatment for autism is listed as:

  • Behavioral health care
  • Pharmacy care
  • Therapeutic care

Insurance plans are allowed to review a child’s treatment plan once every 3 months.

Get Support

South Dakota Insurance Division

Common Violations

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

Common Violations

Definition

Term Name


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