Parity is about fairness. Americans with behavioral health conditions often have more difficulty getting the treatment and services they need when compared to individuals seeking other medical care. Explore parity-related information regarding legislation, statutes, and regulatory actions since the Federal Parity Law was passed in 2008.
Massachusetts Parity Law
Here are links to the sections of Massachusetts law that are relevant to parity and autism coverage:
Behavioral Health Coverage
These sections of the law require large employer fully-insured plans, small employer fully-insured plans, individual plans, and state employee plans to provide behavioral health treatment coverage on a “non-discriminatory basis” for certain conditions.
The law explicitly applies to the following conditions and requires that annual limits,lifetime limits, and quantitative treatment limitations for these conditions are the same as they are for other medical conditions:
- Schizoaffective disorder
- Major depressive disorder
- Bipolar disorder
- Paranoia and other psychotic disorders
- Obsessive-compulsive disorder
- Panic disorder
- Delirium and dementia
- Affective disorders
- Eating disorders
- Post traumatic stress disorder
- Substance abuse disorders
These sections of the law also require individual plans, small employer fully-insured plans, large employer fully-insured plans, and state employee plans to cover treatment of patients with conditions not listed above for at least 60 days of inpatient treatment and 24 outpatient visits, as long as the treatment is considered medically necessary .
These sections of the law also require insurance plans to provide treatment coverage on a “non-discriminatory basis” for victims of rape and assault with intent to commit rape if the costs of treatment are more than the maximum compensation awarded to the victims.
Insurance plans are also required to cover treatment for children under age 19 who do not have any of the conditions listed above who meet these criteria:
- They can’t attend school because of their condition
- The condition requires hospitalization
- Their behavior poses serious danger to themselves or others
The law does cover a full range of inpatient, intermediate, and outpatient services and says treatment may take place in the least restrictive clinically appropriate setting.
- Habilitative or rehabilitative care (included applied behavior analysis )
- Pharmacy care
- Psychiatric care
- Psychological care
- Therapeutic care