Action in the Regulatory Arena
The IDOI requires all plans under their jurisdiction to submit forms that indicate whether they comply with state parity requirements. Here is an example (pdf | Get Adobe® Reader®) of the form used for non-grandfathered individual plans and an example (pdf | Get Adobe® Reader®) of the form used for small employer fully-insured plans (scroll to the top of page 7). IDOI also requires multiple employer welfare arrangements (MEWA) complete a form (pdf | Get Adobe® Reader®) to indicate that they comply with the Federal Parity Law.
The IDOI also has a list of state required benefits. This includes a section on mental health benefits. The document details which plans have to comply with the mandate and the associated statutory citations.
|Primary Focus||Access to Service|
|Agency||Division of Mental Health and Addiction|
|Title/Description||Determining need for a new opioid treatment program|
|Citation||440 Ind. Admin. Code 10-2-3|
Outlines the requirements and factors needed in order to propose a new opioid treatment program in a geographic location. Some factors include emergency room reports including opioid misuse; death reports including opioid misuse, and the presence of pain clinics in the area.
The IDOI held a webinar (pdf | Get Adobe® Reader®) called the Federal Parity Law , Student Health Plans, & Renewal Letters. Slides 7 – 9 address parity . The webinar outlined the main requirements of the Federal Parity Law and defined which plans are subject to it. The webinar also discussed how IDOI checks for compliance with the law.
|Agency||Office of the Secretary of Family and Social Services|
|Title/Description||Mental Health Parity|
|Citation||405 Ind. Admin. Code 10-7-5|
Coverage of mental health care services are subject to the same treatment limitations or financial requirements as coverage of services for physical illness.
The IDOI released an FAQs (pdf | Get Adobe® Reader®) on company compliance with the Affordable Care Act rate and form filing. Questions 54 and 55 relate to parity. The first addresses if health plans can offer separate visit limits for outpatient rehabilitation and habilitation services. The second questions addresses if health plans can have visit limits for applied behavior analysis to treat autism.
The IDOI created an FAQ document about essential health benefits required by the Affordable Care Act. This document explains that small employer fully-insured plans and individual plans must comply with the Federal Parity Law regarding outpatient visit limits, inpatient day limits, lifetime limits, annual maximums, and lifetime maximums.
The document also explains that any treatment limitations in place for physical, occupational, or speech therapy do not apply to applied behavior analysis.
The IDOI issued a bulletin (pdf | Get Adobe® Reader®) about the sections of state law about autism coverage. It clarified that a psychologist or physician specializing in pervasive developmental disorder services may sign the treatment plan for a child with autism spectrum disorder; it does not have to be the child’s primary care practitioner.
|Agency||Department of Insurance|
|Citation||760 Ind. Admin. Code 1-68-4|
Requires Multiple Employer Welfare Arrangements (professional employer organization) to comply with the federal Mental Health Parity Act.
|Effective Date||Original effective date April 15, 2003|
|Notes||Readopted filed November 20, 2015|