California

There are several sections within California law relevant to parity. There is a section found in the state’s Health and Safety Law and another in the State Insurance Law. These sections require individual plans, small and large employer fully-insured plans to offer coverage for the following behavioral health conditions:

1. Schizophrenia
2. Schizoaffective disorder
3. Bipolar disorder
4. Major depressive disorders
5. Panic disorder
6. Obsessive-compulsive disorder
7. Pervasive developmental disorder or autism
8. Anorexia nervosa
9. Bulimia nervosa

These sections require that coverage for these conditions must be “terms and conditions applied to other medical conditions.” It also specifies several classifications of benefits to which the law applies:

1. inpatient services
2. Outpatient services
3. partial hospitalization (intermediate level of care )
4. Prescription medications

Copayments, and coinsurance, and deductibles must be “under the same terms and conditions” as those in place for other medical services.

For children, the law goes beyond the nine conditions listed above and applies to any child that “has one or more mental disorders as identified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) , other than a primary substance use disorder or developmental disorder, that result in behavior inappropriate to the child’s age according to expected developmental norms.”

The law does contain specific language stating insurance plans can require insureds to receive all or part of their mental health services within the geographic region in which they live or work.

The law also specifies that case management, managed care, and utilization management are all allowed.

There is a section of the Health and Safety Law and a section of the Insurance Law that require plans to comply with the Federal Parity Law and “all rules, regulations, and guidance” issued related to the Federal Parity Law.

There is also a section of the state insurance law mandating that all policies of “disability income insurance, that is of a short-term limited duration of two years or less, that is issued, amended, or renewed on or after July 1, 2014, and that provides disability income benefits shall provide coverage for disability caused by severe mental illnesses.”

There are also additional provisions within the Health and Safety Code and the Insurance Code pertaining to pervasive developmental disorder and autism. These provisions mainly provide definitions for the criteria of a provider being considered “qualified autism service professional” and provide some definitions for treatment. However, these sections also require plans to provide “behavioral health treatment” for autism and reiterates that this treatment must meet the conditions of the parity sections summarized above. For further detail, read this provision in the Health and Safety Code, or read the provision in the Insurance Code.