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.
Texas Parity Law
There are 2 sections of the state insurance law relevant to parity. There is one section of the law that addresses mental health and autism coverage, and another that addresses substance use disorders
Because most of the autism requirements are in a separate subsection of the section on mental health and autism coverage, autism coverage will be summarized in a separate section of this page below.
This section applies to large employer fully-insured plans, small employer fully-insured plans, and local government plans. However, the coverage described below is optional for small employer fully-insured plans. Also, there is a separate subsection that applies to local government plans that is very brief (summarized below).
This section only applies coverage to the following conditions, defined in this section as “serious mental illness”:
- Bipolar disorders (hypomanic, manic, depressive, and mixed)
- Depression in childhood and adolescence
- Major depressive disorders (single episode or recurrent)
- Obsessive-compulsive disorders
- Paranoid and other psychotic disorders
- Schizo-affective disorders (bipolar or depressive)
This section specifies that at least 45 inpatient days and 60 outpatient visits are required of plans affected by the law and states that plans “must include the same amount limitations, deductibles , copayments , and coinsurance factors for serious mental illness as the plan includes for physical illness.” It also states that plans “must provide coverage for an outpatient visit under the same terms as the coverage the issuer provides for an outpatient visit for the treatment of physical illness.”
This section also forbids any lifetime limitations within a plan for inpatient days and outpatient visits.
This section specifies that plans offering coverage in a hospital for a child or adolescent with a “mental or emotional illness or disorder” must provide coverage for the child in a “residential treatment center for children and adolescents or a crisis stabilization unit that is at least as favorable as the coverage the plan provides for treatment of mental or emotional illness or disorder in a hospital.” It also specifies that each two days of treatment in a residential treatment center or crisis stabilization unit are equivalent to one day of coverage for treatment in a hospital.
This section also has specific language addressing partial hospitalization. It specifies that plans that offer inpatient coverage must also provide coverage for “psychiatric day treatment.” It also specifies that each day of coverage for psychiatric day treatment is equivalent to one-half day of coverage for inpatient or hospital care.
This section explicitly allows plans to use managed care.
This section also has a small subsection that mandates that local governments may not provide coverage for serious mental illness that is that is “less extensive than the coverage provided for any other physical illness.”
The subsection within the mental health coverage section requires individual plans, small employer fully-insured plans, and large employer fully-insured plans to provide autism screening at 18 and 24 months. The subsection pertaining to autism also lists a number of “generally recognized services” for autism treatment:
- Evaluation and assessment services
- Applied behavior analysis
- Behavior training and behavior management
- Speech therapy
- Occupational therapy
- Physical therapy
- Medications or nutritional supplements used to address symptoms of autism spectrum disorder
This subsection defines autism spectrum disorder as “a neurological disorder that includes autism, Asperger’s syndrome, or Pervasive Developmental Disorder–Not Otherwise Specified.”
Deductibles, copayments, and coinsurance must be equivalent to those in place for other medical services. Plans are not required to pay more than $36,000 in a year for applied behavior analysis for children age 10 and older.
Substance Use Disorder
This section requires that treatment for chemical dependency is covered that is not “less favorable” that coverage for other medical care. It also specifies that durational limits, dollar limits, deductibles , and coinsurance must be the same as treatment coverage for other care. However, there is a significant caveat that a plan is only required to cover three separate treatment series during the lifetime of the plan for each enrollee.