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.

West Virginia Parity Law

There are multiple sections of the state insurance law relevant to parity. They are summarized below in 4 different sections:

  • Behavioral Health Coverage for Group Plans
  • Behavioral Health Coverage for State Employee Plans
  • Mental Health Coverage for Individual plans
  • Autism Coverage

Behavioral Health Coverage for Group Plans

This section requires large employer fully-insured plans and small employer fully-insured plans to cover services for the following behavioral health conditions:

  • Schizophrenia and other psychotic disorders
  • Bipolar disorders
  • Depressive disorders
  • Substance use disorders
  • Anxiety disorders
  • Anorexia
  • Bulimia

The section makes clear that quantitative treatment limitations, financial requirements, and non-quantitative treatment limitations must be applied similarly for behavioral health services and other medical services.

Plans may use “whatever cost containment measures may be necessary,” including day and visit limits on inpatient care and outpatient care if they can prove that complying with this section of the law causes total costs to rise by at least 2%.

Plans are explicitly exempted from covering residential treatment.

Behavioral Health Coverage for State Employee Plans

This section requires state employee plans to cover services for the following behavioral health conditions:

  • Schizophrenia and other psychotic disorders
  • Bipolar disorders
  • Depressive disorders
  • Substance use disorders
  • Anxiety disorders
  • Anorexia
  • Bulimia
  • Attention deficit hyperactivity disorder through age 18
  • Separation anxiety disorder through age 18
  • Conduct disorder through age 18

The section makes clear that non-quantitative treatment limitations must be applied similarly for behavioral health services and other medical services.

Plans may use “whatever cost containment measures may be necessary,” including day and visit limits on inpatient care and outpatient care if they can prove that complying with this section of the law causes total costs to rise by at least 2%.

Plans are explicitly exempted from covering residential treatment.

Mental Health Coverage for Individual Plans

This section requires individual plans to offer optional coverage for any mental health condition that meets the following requirements:

Autism Coverage

These are the sections in the state insurance law about autism coverage:

These sections are identical except for the last two, which apply to the Children’s Health Insurance Program in West Virginia and state employee plans. The only difference in these two sections is that they requires an annual report about the number of children receiving autism coverage because of these sections, the sections’ fiscal impact, and any recommendations for changing the law or policies related to the law.

These sections require large employer fully-insured plans and small employer fully-insured plans with more than 25 employees to cover autism services for children age 18 months through 18 years of age, as long as they received a diagnosis before age 9.

Plans are required to cover an annual maximum for applied behavior analysis of $30,000 for the first 3 years of treatment after a diagnosis and $2,000 per month for every year afterwards through age 18.

The child’s provider must provide the insurance plan with a report every 6 months for coverage to continue. This report must include the following information for coverage to continue:

  • The child’s condition is improving because of treatment
  • Maximum improvement is still to come
  • This improvement is expected to occur “in a reasonable and generally predictable period of time”

Autism spectrum disorder is defined as “any pervasive developmental disorder, including autistic disorder, Asperger’s Syndrome, Rett syndrome, childhood disintegrative disorder, or Pervasive Development Disorder as defined” in the DSM.

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.