Definition


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Legislation Signed into Law

2018

Primary Focus Medicaid
Title/Description Medicaid-covered specialty services and supports; management and delivery; specialty prepaid health plans
Citation Michigan Compiled Laws § 400.109f
Summary

The state department shall support the use of Medicaid funds for specialty services and supports for Medicaid beneficiaries with a serious mental illness, developmental disability, serious emotional disturbance, or substance use disorder.

Effective Date 3/20/2018
Notes

Enacted through SB 649 (Regular Session 2017)

2016

Primary Focus Disability Insurance
Title/Description Diagnosis and treatment of autism spectrum disorders; coverage; prohibition; availability of other benefits; conditions; qualified health plan offered through American health benefit exchange pursuant to federal law; short-term or 1-time limited duration policy or certificate; prescription drug plan; coordinated benefits; definitions
Citation Michigan Compiled Laws § 500.3406s
Summary

This statute requires an insurer that delivers a health insurance policy shall provide coverage for the diagnosis of autism spectrum disorders and treatment of autism spectrum disorders. Insurers are prohibited from terminating or refusing to provide coverage solely based on an individual’s diagnosis with autism spectrum disorder. Insurers cannot limit the number of visits used for treatment of autism spectrum disorders, or deny or limit coverage because the treatment is educational or habilitative in nature. An insurer may limit coverage for treatment of autism spectrum disorders to an insured enrollee through 18 years old and may apply a maximum annual benefit amount. Insurers may apply certain coverage conditions to treatment for an autism spectrum disorder.

Effective Date 7/1/2016
Notes

Enacted through HB 4935 (Regular Session 2016)

Primary Focus Mandated Benefit: substance use disorders
Title/Description Health insurance policies; coverage for intermediate and outpatient care for substance abuse disorder required; charges, terms and conditions; reduction of coverage; deductibles and copayment provisions; definitions
Citation Michigan Compiled Laws § 500.3425
Summary

An insurer that delivers a health insurance policy shall provide coverage for intermediate and outpatient care for substance use disorder. The charges, terms, and conditions for coverage of such services shall not be less favorable than the maximum prescribed for other comparable services. The insurer shall not reduce coverage required for such services by terms or conditions applicable to other items of coverage in the policy.

Effective Date 7/1/2016
Notes

Enacted through HB 4935 (Regular Session 2016)

2011-2012

SB 414
Senate Bill SB 415
Introduced 6/2011
Sponsor Sen. Green and Sen. Hunter
Status Signed into Law 4/2012
Summary This bill added the section to the state insurance law about autism coverage (that section is summarized at the bottom of this page under “Michigan Parity Law,” “Autism Coverage”)
Primary Focus Mandated Benefit: Provider
Title/Description Diagnosis and treatment of autism spectrum disorders; coverage; prohibition; availability of other benefits; conditions; qualified health plan offered through American health benefit exchange pursuant to federal law; prescription drug plan; coordinated benefits; definitions
Citation Michigan Compiled Laws § 550.1416e
Summary

A health care corporation group or nongroup certificate shall provide coverage for the diagnosis of autism spectrum disorders and treatment of autism spectrum disorders. Insurers cannot limit the number of visits used for treatment of autism spectrum disorders, or deny or limit coverage because the treatment is educational or habilitative in nature. An insurer may limit coverage for treatment of autism spectrum disorders to an insured enrollee through 18 years old and may apply a maximum annual benefit amount. Insurers may apply certain coverage conditions to treatment for an autism spectrum disorder.

Effective Date 4/18/2012
Notes

Enacted through SB 414 (2011 Regular Session)

National Parity Map

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National Parity Map

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Common Violations

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