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.
Minnesota Parity Law
Minnesota state insurance law has several sections about coverage for behavioral health conditions. Minnesota’s law is not a comprehensive parity law because it does require insurance plans to provide behavioral health coverage. It only applies to plans that do offer behavioral health coverage.
Chapter 62Q Section 47 of the state insurance law says that insurance plans cannot place a “greater financial burden” on consumers for inpatient and outpatient behavioral health services than what is in place for other medical services. Plans also cannot have treatment limitations for inpatient and outpatient behavioral health services that are “more restrictive” than limitations used for other medical services. This section of the law also says that all plans have to meet the requirements of the Federal Parity Law and the Affordable Care Act .
Chapter 62Q Section 53 of the state insurance law defines medically necessary care for mental health treatment and says that insurance plans cannot use a more restrictive definition. The law specifies that “health care services appropriate, in terms of type, frequency, level, setting, and duration, to the enrollee’s diagnosis or condition, and diagnostic testing and preventive services. Medically necessary care must be consistent with generally accepted practice parameters as determined by health care providers in the same or similar general specialty as typically manages the condition, procedure, or treatment at issue and must:
- Help restore or maintain the enrollee’s health; OR
- Prevent deterioration of the enrollee’s condition
Chapter 62A Section 3094 requires large employer fully-insured plans to cover services for autism for children under age 18. The law defines autism spectrum disorders as any conditions classified as such in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The law states that insurance plans must cover “medically necessary care.” In the law, medically necessary care “must be consistent with generally accepted practice parameters as determined by physicians and licensed psychologists who typically manage patients who have autism spectrum disorders.”
The law specifically requires insurance plans to cover all of the following:
- All types of applied behavior analysis, intensive early intervention behavior therapy, and intensive behavior intervention
- Neurodevelopmental and behavioral health treatments and management
- Speech therapy
- Occupational therapy
- Physical therapy
Coverage must also include anything that is part of an individualized treatment plans prescribed for the child by his or her physician or mental health professional.
Insurance plans are allowed to request an updated treatment plan no more often than once every six months. However insurance plans are allowed to have an independent professional with training in autism spectrum disorder and child development perform an evaluation to determine if the patient is making progress under the treatment plan. There is no language explaining what plans can or cannot do if it is determined that the child is not progressing.
- Minnesota Insurance Division