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.
Missouri Parity Law
There are multiple sections of Missouri’s insurance law that are relevant to parity:
- Section 376.1550 requires insurance plans to cover mental health services, but not substance use disorder services; it does not apply individual plans
- Section 376.811 allows plans to offer optional behavioral health coverage for all plan types
- Section 376.779 requires individual plans to cover services for “alcoholism”
- Section 376.1224 requires small employer fully-insured plans, large employer fully-insured plans, and some state and local government plans to cover autism services
Each section will be described separately with explanations of its relationship with other sections, when necessary.
This section requires all small employer fully-insured plans, large employer fully-insured plans and state employee plans to cover all mental health conditions in the DSM; it specifically exempts coverage for substance use disorders instead stating that plans have to comply with 376.811. It forbids plans from having any lifetime limits, annual limits, copayments, coinsurance, outpatient visit limits for mental health services that are more expensive or restrictive than those in place for other medical services. It requires plans to have one deductible or out-of-pocket limit for both mental health services and other medical services. It does not address inpatient day limits.
This section allows plans to use managed care for mental health coverage even if they do not use managed care for other medical coverage. It also allows plans to use a more involved form of managed care for mental health coverage than what they use for other medical coverage. However, it does state that administrative and clinical procedures should “not serve to reduce access to medically necessary treatment”. This could be interpreted as addressing non-quantitative treatment limitations such as medical necessity review, prior authorization, and step therapy.
This section also allows employers to apply for a waiver exempting them from this section of the law if they can show that their plan’s compliance with this section caused premiums to increase by at least 2%.
This section requires individual plans, small employer fully-insured plans, and large employer fully-insured plans to offer optional behavioral health coverage that individuals and employers can accept or reject.
Because section 376.1550 requires small employer fully-insured plans and large employer fully-insured plans to cover mental health services, the parts of this section about mental health coverage only apply to individual plans, with some possible exceptions (explained below).
The offered coverage for substance use disorder services must meet the following requirements:
- 26 visits of outpatient care and partial hospitalization
- 21 days of residential treatment
- 6 days of detoxification
- A lifetime limit of 10 episodes of treatment, with episode defined as “a distinct course of chemical dependency treatment separated by at least thirty days without treatment”
- Financial requirements that are equal to those used for other medical services
The offered coverage for mental health services must meet the following requirements:
- Outpatient care and partial hospitalization equal to what is in place for other medical conditions
- Coinsurance, copayment, deductible, annual maximum and lifetime maximum that are equal to what is in place for other medical services
- Residential treatment equal to what is in place for other medical conditions
- At least 90 days of inpatient care
It is possible that the last two parts about residential treatment are relevant for small employer fully-insured plans and large employer fully-insured plans because section 376.1550 does not list any requirements about residential treatment or inpatient care.
This section of the law also has an outdated subsection that requires plans to comply with sections of the law that expired in 2011 if an individual or employer rejects the behavioral health coverage offer.
- Section 376.779 requires individual plans, small employer fully-insured plans, and large employer fully-insured plans to cover services for “alcoholism”
This section only applies to individual plans and requires them to cover at least 30 days of inpatient or residential treatment for alcoholism. Plans are not allowed to deny coverage for any services at a facility certified by the state’s Department of Mental Health. This section is superseded by section 376.811 if an individual accepts the offer of behavioral health coverage as part of his plan, as described in section 376.811.
This section requires autism coverage for small employer fully-insured plans, large employer fully-insured plans, self-insured governmental plans, self-insured school district plans, and several other forms of self-insured plans that are not under ERISA. Some of the most significant requirements of this section are:
- Coverage for Autistic Disorder, Asperger’s Disorder; Pervasive Developmental Disorder not Otherwise Specified, Rett’s Disorder, and Childhood Disintegrative Disorder
- $40,000 annual maximum for applied behavior analysis for children through age 18; other treatments are not subject to this annual maximum or age limitation (dollar amount is adjusted for inflation each year)
- No outpatient visit limits
- Coverage of psychiatric care, psychological care, habilitative or rehabilitative care, therapeutic care, and pharmacy care (all of these are defined in the section)
- Insurance plans can only review a treatment plan once every six months
- Financial requirements must be the same as what are in place for other medical services
Individual plans are not required to cover autism services, but they must offer it as optional coverage.
All plans are exempt from covering any services that are classified as a Part C early intervention program.
Small employers can apply for an exemption if they can show their premium costs increased by at least 2.5% in any 12-month period.
The section does not apply to Missouri HealthNet plans (Medicaid).