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Legislation Signed into Law

2018

Primary Focus: Mental Health Education in Schools
Title/Description: Physical and Health Education
Citation: Va. Code Ann. § 22.1–207
Summary: Va. Code Ann. § 22.1–207 was amended to require mental health education in public schools. The Board of Education is required to consult with mental health experts and shall review and update the health Standards of Learning for students in the 9th and 10th grades to include mental health. The health instruction will incorporate standards that recognize the dimensions of health including mental health and the relationship of physical and mental health to enhance student understanding, attitudes and behavior to promote dignity, health, and well-being. The second amendment to Va. Code. Ann. § 22.1–207 includes age-appropriate health instruction on the safe use and risk of abuse of prescription drugs.
Effective Date: HB 1604 approved March 19, 2018. HB 1532 approved March 23, 2018.
Notes: House Bill 1604 and House Bill 1552 provided for these amendments.

2015

Primary Focus: Mandated Benefits; Provider
Title/Description: Coverage for mental health and substance use disorders
Citation: Va. Code Ann. § 38.2-3412.1
Summary: Group and individual health insurance coverage must provide mental health and substance use disorder benefits. Such benefits shall be in parity with the medical and surgical benefits contained in the coverage in accordance with the Mental Health Parity and Addiction Equity Act of 2008.
Effective Date: July 1, 2015
Notes: Enacted through HB 1747 (2015 Session)

HB 1940
Introduced: 1/2015
Sponsor: Del. Greason
Status: Signed into law 3/2015
Summary: This bill changed the section of the insurance law about autism coverage to what it is currently by raising the age limit for coverage to age 10 and by eliminating language that defined small employer plans as those with 50 or fewer employees.

2013

HB 1900
Introduced: 1/2013
Sponsor: Del. Rust
Status: Signed into law 4/2013
Summary: Among many other things, this bill changed the parity section of the state insurance law by clarifying that anything in this section does not apply if it conflicts with another section of the law related to implementing the Affordable Care Act.

2011

Primary Focus: Mandated Benefits; Provider
Title/Description: Coverage for autism spectrum disorder
Citation: Va. Code Ann. § 38.2-3418.17
Summary: Mandates coverage for the diagnosis of autism spectrum disorder and the treatment of autism spectrum disorder, in individuals (i) from January 1, 2012, until January 1, 2016, from age two years through age six years and (ii) from and after January 1, 2016, from age two years through age 10 years, subject to the annual maximum benefit limitation.
Effective Date: April 29, 2011
Notes: Enacted through H1940 (2015 Session)

HB 2467/SB 1062
Introduced: 1/2011
Sponsor: Del. Greason and Sen. Howell
Status: Signed into law 4/2011
Summary: This bill added the section of the state insurance law about autism coverage. This section is summarized at the bottom of this page under “Virginia Parity Law,” “Autism Coverage.” The only thing that has changed in this section since this bill became law is that the age limit for coverage has been raised to age 10 from age 6.

2010

SB 706
Introduced: 1/2010
Sponsor: Sen. Houck
Status: Signed into law 4/2010
Summary: This bill changed the parity section of the state insurance law so that large employer fully-insured plans must cover behavioral health services “in accordance” with the Federal Parity Law.

Virginia Parity Law

There are several sections of state law relevant to parity. They are summarized below in three parts: Behavioral health coverage, state employee behavioral health coverage, and autism coverage.

There was a section (38.2-3412.1:01) about coverage requirements for “biologically-based mental illness” that was repealed in 2015 because amendments to another section of the state insurance law made 38.2-3412.1:01 obsolete and irrelevant. That section is not summarized here because it is no longer in the state insurance law. If you would like to know what was in that section, contact us at info@paritytrack.org.

Behavioral Health Coverage

This section requires large employer fully-insured plans, individual plans, and non-grandfathered small employer fully-insured plans to cover behavioral health services and provide those services in a way that meets the standards of the Federal Parity Law, even if the Federal Parity Law does not directly apply to a particular plan.

This section requires the following for grandfathered small employer fully-insured plans:

  • 20 days of inpatient care for adults (inpatient care is defined to include residential – treatment)
  • 25 days of inpatient care for children
  • Up to 10 days of inpatient care can be turned into 15 days of partial hospitalization (1 for 1.5 ratio; 4 inpatient days could be come 6 days of partial hospitalization, for example)
  • 20 visits for outpatient care
  • Medication management visits do not count towards outpatient visit limit
  • For any coinsurance, a plan must cover at least 50% for the first 5 outpatient visits
  • Any outpatient visit that is not covered because the person has not yet met the plan –deductible does not count towards the 20 visit limit

State Employee Plan Behavioral Health Coverage

This section requires state employee plans must cover “biologically based mental illness” and have the same coinsurance, copayments, annual maximums, lifetime maximums, annual limits, and lifetime limits as what are in place for other medical treatment. There must be just one combined deductible for “biologically-based mental illness” and other medical treatment. Medical necessity reviews for “biologically-based mental illness” must be conducted “in the same manner” as those for other medical treatment. “Biologically-based mental illness” is defined as:

  • Schizophrenia
  • Schizoaffective disorder
  • Bipolar disorder
  • Major depressive disorder
  • Panic disorder
  • Obsessive-compulsive disorder
  • Attention deficit hyperactivity disorder
  • Autism
  • Drug and alcoholism addiction

Autism Coverage

This section requires large employer fully-insured plans, state employee plans, local government plans, and public school employee plans to cover autism services for children age 2 through age 10.

Autism spectrum disorder is defined as “any pervasive developmental disorder, including autistic disorder, Asperger’s Syndrome, Rett syndrome, childhood disintegrative disorder, or Pervasive Developmental Disorder – Not Otherwise Specified, as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.”

Autism treatment is defined as:

(All of these are defined in detail in the law)

There is a $35,000 annual maximum for applied behavior analysis.

Plans cannot have any visit limits for outpatient care, and financial requirements have to be the same as what are in place for other medical services.

Plans are allowed to review a child’s treatment plan once every 12 months.

Medical necessity reviews must conducted “in the same manner” as reviews for other medical services.

Plans are exempt from this section of the law if they can prove that complying with this section caused premiums to increase by at least 1% in a given year.

Get Support

Virginia Insurance Division

  •   Website
  • bureauofinsurance@scc.virginia.gov
  • 1-877-310-6560

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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