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This page lists some of the action toward parity compliance undertaken by state regulatory agencies since 2008.

Are we missing any actions taken by state regulatory agencies? Let us know at info@paritytrack.org

Action in the Regulatory Arena

Summer 2015

SB 108 from the 2014 Legislative session required the Department of Human Services and the Department of Labor and Regulation to conduct a study about autism services and insurance coverage for autism services, including associated costs. The departments presented this slide deck (pdf | Get Adobe® Reader®) that chronicles the findings related to insurance coverage.

Spring 2015

The Division of Insurance released its seasonal newsletter (pdf | Get Adobe® Reader®) to consumers. This newsletter contained a section that informed consumers about the recently passed legislation about autism coverage (page 3 of the newsletter).

12/2014

Primary Focus Mandated Benefit
Agency Public Utilities Commission
Title/Description Classifications of benefits used for applying rules
Citation ARSD 20:06:58:12
Summary

If a plan, or health insurance coverage, provides mental health or substance use disorder benefits, mental health or substance use disorder benefits must be provided in every classification in which medical or surgical benefits are provided. A plan or health insurance issuer, must apply the same standards to medical or surgical benefits and to mental health or substance use disorder benefits.

Effective Date 12/3/2014
Notes 41 SDR 93
Primary Focus Access to Services
Agency Public Utilities Commission
Title/Description Special rule for multi-tiered prescription drug benefits
Citation ARSD 20:06:58:19
Summary

If a plan, or health insurance coverage, applies different levels of financial requirements to different tiers of prescription drug benefits, relating to requirements for nonquantitative treatment limitations, and without regard to whether a drug is generally prescribed with respect to medical or surgical benefits or with respect to mental health or substance use disorder benefits, the plan, or health insurance coverage, satisfies the parity requirements

Effective Date 12/3/2014
Notes 41 SDR 93
Primary Focus Mandated Benefit
Agency Public Utilities Commission
Title/Description Application to out-of-network providers
Citation ARSD 20:06:58:13
Summary

A plan, or health insurance coverage, that provides mental health or substance use disorder benefits in any classification of benefits must provide mental health or substance use disorder benefits in every classification in which medical or surgical benefits are provided, including out-of-network classifications.

Effective Date 12/3/2014
Notes 41 SDR 93
Primary Focus Access to Services
Agency Public Utilities Commission
Title/Description Special rule for multiple network tiers
Citation ARSD 20:06:58:20
Summary

If a plan, or health insurance coverage, provides benefits through multiple tiers of in-network providers, the plan may divide its benefits furnished on an in-network basis into sub-classifications that reflect network tiers, without regard to whether a provider provides services with respect to medical or surgical benefits or mental health or substance use disorder benefits. The plan or issuer may not impose any financial requirement or treatment limitation on mental health or substance use disorder benefits in any sub-classification that is more restrictive than the predominant financial requirement or treatment limitation that applies to substantially all medical or surgical benefits.

Effective Date 12/3/2014
Notes 41 SDR 93
Primary Focus Mandated Benefit
Agency Public Utilities Commission
Title/Description Plan with a limit on at least two-thirds of all medical or surgical benefits
Citation ARSD 20:06:58:04
Summary

A plan or health insurance coverage that includes an aggregate lifetime or annual dollar limit on at least two-thirds of all medical or surgical benefits, must either: apply the aggregate lifetime or annual dollar limit both to the medical or surgical benefits to which the limit would otherwise apply and to mental health or substance use disorder benefits, or not include an aggregate lifetime or annual dollar limit on mental health or substance use disorder benefits that is less than the aggregate lifetime or annual dollar limit, respectively, on medical or surgical benefits.

Effective Date 12/3/2014
Notes 41 SDR 93
Primary Focus Mandated Benefit
Agency Public Utilities Commission
Title/Description General parity requirement
Citation ARSD 20:06:58:11
Summary

A group health plan, or health insurance coverage offered by an issuer in connection with a group health plan, that provides both medical or surgical benefits and mental health or substance use disorder benefits may not apply any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification this is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all, medical or surgical benefits, in the same classification.

Effective Date 12/3/2014
Notes 41 SDR 93
Primary Focus Mandated Benefit
Agency Public Utilities Commission
Title/Description Nonquantitative treatment limitations
Citation ARSD 20:06:58:23
Summary

A group health plan, or health insurance coverage, may not impose a nonquantitative treatment limitation with respect to mental health or substance use disorder benefits in any classification unless, under the terms of the plan, or health insurance coverage, any processes, strategies, evidentiary standards, or other factors used in applying the nonquantitative treatment limitation to mental health or substance use disorder benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation with respect to medical or surgical benefits in the classification.

Effective Date 12/3/2014
Notes 41 SDR 93
Primary Focus Mandated Benefit and Access to Services
Agency Public Utilities Commission
Title/Description Plan with no limit or limits on less than one-third of all medical or surgical benefits
Citation ARSD 20:06:58:03
Summary

If a plan, or health insurance coverage, does not include an aggregate lifetime or annual dollar limit on any medical or surgical benefits or includes an aggregate lifetime or annual dollar limit that applies to less than one-third of all medical or surgical benefits, it may not impose an aggregate lifetime or annual dollar limit, respectively, on mental health or substance use disorder benefits.

Effective Date 12/3/2014
Notes 41 SDR 93
Primary Focus Mandated Benefit and Access to Services
Agency Public Utilities Commission
Title/Description Plan not described in sections 20:06:58:03 or 20:06:58:04 of this chapter
Citation ARSD 20:06:58:06
Summary

A group health plan, or health insurance coverage, with respect to aggregate lifetime or annual dollar limits on medical or surgical benefits must either: impose no aggregate lifetime or annual dollar limit, as appropriate, on mental health or substance use disorder benefits; or impose an aggregate lifetime or annual dollar limit on mental health or substance use disorder benefits that is no less than an average limit calculated for medical or surgical benefits

Effective Date 12/3/2014
Notes 41 SDR 93
Primary Focus Primary Focus:
Agency Public Utilities Commission
Title/Description No separate cumulative financial requirements or cumulative quantitative treatment limitations
Citation ARSD 20:06:58:22
Summary

A group health plan, or health insurance coverage, offered in connection with a group health plan, may not apply any cumulative financial requirement or cumulative quantitative treatment limitation for mental health or substance use disorder benefits in a classification that accumulates separately from any established for medical or surgical benefits in the same classification.

Effective Date 12/3/2014
Notes 41 SDR 93
Primary Focus Mandated Benefit
Agency Public Utilities Commission
Title/Description Financial requirements and quantitative treatment limitations — Determining substantially all
Citation ARSD 20:06:58:14
Summary

 If a type of financial requirement or quantitative treatment limitation does not apply to at least two-thirds of all medical or surgical benefits in a classification, then that type cannot be applied to mental health or substance use disorder benefits in that classification.

Effective Date 12/3/2014
Notes 41 SDR 93
Primary Focus Mandated Benefit and Access to Services
Agency Public Utilities Commission
Title/Description Special rule for sub-classifications permitted for office visits, separate from other outpatient services
Citation ARSD 20:06:58:21
Summary

A plan or issuer may not impose any financial requirement or quantitative treatment limitation on mental health or substance use disorder benefits in any sub-classification that is more restrictive than the predominant financial requirement or quantitative treatment limitation that applies to substantially all medical or surgical benefits

Effective Date 12/3/2014
Notes 41 SDR 93

09/2010

Primary Focus Mandated Benefit and Access to Services
Agency Public Utilities Commission
Title/Description Individual plans — Lifetime limits
Citation ARSD 20:06:55:21
Summary

No individual policy of insurance may establish a lifetime limit on the dollar value of essential benefits for any covered person or an unreasonable annual limit on the dollar value of essential benefits for any covered person. Essential benefits include ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services including oral and vision care.

Effective Date 9/23/2010
Notes 37 SDR 63 (9/23/2010), 37 SDR 111 (effective 12/7/2010)
Primary Focus Mandated Benefit and Access to Services
Agency Public Utilities Commission
Title/Description Group plans — Lifetime limits
Citation ARSD 20:06:55:15
Summary

A group health plan may not establish any lifetime limit or any annual limit on the dollar amount of essential benefits for any individual. Essential benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care.

Effective Date 9/23/2010
Notes 37 SDR 63 (9/23/2010), 37 SDR 111 (effective 12/7/2010)

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

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Common Violations

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