Definition


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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.

Montana Parity Law

The sections of Montana law that are relevant to parity are found in the state’s insurance law. There is one section for behavioral healthcoverage and another section for autism coverage.

Behavioral Health

This section of the law has a subsection for “severe mental illness” and a several subsections for other mental health conditions and substance use disorders.

Severe mental illness is defined by the subsection as:

  • Schizophrenia
  • Schizoaffective disorder
  • Bipolar disorder
  • Major depression
  • Panic disorder
  • Obsessive compulsive disorder
  • Autism (this section indicates that plans must comply with the autism section of the law)

This subsection requires large employer fully-insured plans, small employer fully-insured plans, and individual plans to cover services for these conditions in a way that is “no less favorable” than coverage for other medical services. It states that this coverage should include, but not be limited to, inpatient care, outpatient care, rehabilitative services, and medication.

The subsections of the law about other behavioral health conditions require large employer fully-insured plans and small employer fully-insured plans to cover the following:

  • 21 days of inpatient care for mental health conditions
  • 1 inpatient day can be traded for 2 days of partial hospitalization
  • $2,000 annual maximum for outpatient care for mental health conditions
  • $6,000 annual maximum for substance use disorder treatment
  • $12,000 lifetime maximum for substance use disorder treatment (annual maximum is reduced to $2,000 when the lifetime maximum is met)

This subsection specifically excludes eating disorders besides anorexia and bulimia, developmental disorders, speech disorders, and impulse control disorders besides intermittent explosive disorder and trichotillomania.

Autism

This section requires large employer fully-insured plans, small employer fully-insured plans, and state or local government employee plans to cover autism services through age 18. It defines autism spectrum disorder as:

  • Autistic disorder
  • Asperger’s disorder
  • Pervasive developmental disorder not otherwise specified

It lists treatment of autism as:

  • Medications (pharmacy care)
  • Psychological care
  • Psychiatric care
  • Habilitative and rehabilitative care (includes applied behavior analysis )

All of these forms of care are further defined in this section of the law.

It requires plans cover an annual maximum of $50,000 age 8 and younger and an annual maximum of $20,000 for children age 9 through 18.

It states that copayments, coinsurance, and deductibles that do not apply to other medical services cannot be used for autism services.

Insurance plans are only allowed to review a child’s treatment plans once every 6 months.

State Parity Reports

View the state parity reports to learn about legislation, regulation, and litigation related to parity implementation

State Parity Reports

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Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.