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.
South Dakota Parity Law
There are several sections of the law addressing behavioral health coverage and autism coverage:
- Mental Health Coverage (there are many different identical sections regarding mental health coverage that apply to different kinds of plans; for the sake of simplicity we have linked to only one; email firstname.lastname@example.org for links to the other sections)
- Substance use disorder coverage (there are many different identical sections regarding substance use disorder coverage that apply to different kinds of plans; for the sake of simplicity we have linked to only one section and its composite subsections; email email@example.com for links to the other sections)
- Autism Coverage (all of the below links are brief subsections that make up the autism section of the law)
Mental Health Coverage
- Schizophrenia and other psychotic disorders
- Bipolar disorder
- Major depression
- Obsessive compulsive disorder
Substance Use Disorder Coverage
Individual plans, small employer fully-insured plans, and large employer fully-insured plans are required to offer optional coverage for “treatment of alcoholism.” If a plan enrollee chooses a plan with this coverage, the plan must cover at least 30 days of inpatient care during any 6-month time period and have a lifetime limit of at least 90 days of inpatient care.
There is also a condition in the state insurance law forbidding insurance plans from excluding coverage of injuries sustained while a person was under the influence of drugs and alcohol. For example, a plan may not refuse to cover treatment for a broken arm because the person was under the influence of drugs or alcohol when the injury occurred. However, plans can exclude coverage for any “sickness or injury caused in the commission of a felony.”
Large employer fully-insured plans, self-insured non-federal governmental plans (except for South Dakota’s state employee plan), some individual plans, and some small employer fully-insured plans are required to cover applied behavior analysis as follows:
- $36,000 annual maximum through age 6
- $25,000 annual maximum for age 7 through age 13
- $12,000 annual maximum age 14 through age 18
Autism spectrum disorder is defined as “a complex neurodevelopmental medical disorder characterized by social impairment, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior.” There is no mention of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or any other officially recognized diagnostic guide.
Treatment for autism is listed as:
- Behavioral health care
- Pharmacy care
- Therapeutic care
Insurance plans are allowed to review a child’s treatment plan once every 3 months.