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.
Nebraska Parity Law
There is a section of the state insurance law about parity for mental illness, another section about “coverage for treatment of alcoholism,” and another section about autism coverage.
Mental Health Coverage
The section about mental health coverage is actually several small sections of the state insurance law:
These sections of the law do not require any plans to cover mental health services, but have requirements if plans do provide coverage. Theses sections apply to large employer fully-insured plans and small employer fully-insured plans, except for those with 15 employees or less. The law only applies to coverage for these conditions:
- Schizo-affective disorder
- Delusional disorder
- Bipolar disorder
- Major depression
- Obsessive compulsive disorder
If plans cover services for these conditions they cannot have different annual maximums or lifetime maximums than those in place for other medical services. Limits for outpatient care and inpatient care must be the same as well.
If a plan uses a deductible, there must be only one deductible for both mental health services and other medical services.
Plans are explicitly allowed to use non-quantitative treatment limitations for mental health services and there is no language stating that they must be used similarly to how they are for other medical services.
If a plan does not cover mental health services, it must “provide clear and prominent notice of such non-coverage.”
These sections of the law make clear that they do not apply to substance use disorder services.
The section of the law about “alcoholism coverage” is actual several small sections:
These sections of the law define “basic coverage for treatment of alcoholism” if it covers 30 days of inpatient care for alcoholism treatment in any given year and 60 outpatient visits over the life of a policy. However, this section of the law does not require plans to provide this coverage and explicitly states that plans can provide lesser coverage.
This section of the law requires large employer fully-insured plans, small employer fully-insured plans, individual plans, and any self-insured plans that are not exempted by federal law (mostly state and local government self-insured plans) to cover autism services for individuals through age 20. However, this section explicitly does not apply to non-grandfathered small employer fully-insured plans and individual plans that are required to cover essential health benefits under the Affordable Care Act.
Plans must cover 25 hours per week of “behavioral health treatment” (applied behavior analysis) and cannot subject any other form of autism treatment to any sort of annual maximum, lifetime maximum, annual limit, or lifetime limit.
Plans must use the same financial requirements for autism services as are in place for other medical services.
An insurance plan can only review a child’s treatment plan once every 6 months.
The following are considered legitimate treatments for autism:
- Nebraska Insurance Division