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Linda Bohrer, Acting Director

 

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Thursday, August 28, 2008

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Mental Health Parity FAQ

Are group health insurers required to provide benefits for residential treatment programs for mental health conditions?
It is the mental health condition that is the determining factor whether or not residential treatment will be covered. Residential treatment of chemical dependency would be covered by sections 376.779, 376.810-376.14 and 376.825-376.836, RSMo, for both individually underwritten and group health plans. All other conditions, as they as classified in the Diagnostic and Statistical Manual of Mental Disorders IV, would be covered by section 376.1550, RSMo. Per section 376.1550, if the mental health condition is a covered condition and the treatment is medically or clinically necessary, not rendered or billed by a school or halfway house, not experimental or custodial, and clinically and immediately appropriate, then the group health insurer is required to provide benefits for residential treatment programs.
How does the change in mental health parity affect self-funded plans that do not fall under ERISA (i.e. church and governmental plan)?
Self-funded plans, whether they fall under ERISA or not, are not subject to the jurisdiction of DIFP. Therefore, DIFP defers to the courts of Missouri for guidance on this issue.
Does limitation of anti-depressants under the prescription coverage of a health plan violate the new mental health parity law?
The limitation cannot place a greater financial burden on the insured than for access to treatment for a physical health condition.
Does section 376.779, RSMo, apply to group major medical contracts?
Yes, section 376.779, RSMo, applies to chemical dependency coverage in HIPAA employer group major medical plans.
What specific categories of the Diagnostic and Statistical Manual of Mental Disorders IV apply to section 376.1550, RSMo?
Other than chemical dependency classifications, section 376.1550, RSMo, covers any classification defined and listed in the most recent addition of the Diagnostic and Statistical Manual of Mental Disorders.
Would carriers now be required to cover remedial reading and other forms of special education for conditions related to autistic disease of childhood or hyperkinetic syndrome? Does House Bill 855 require carriers to provide coverage for training for learning disabilities, developmental delays, mental retardation and autistic disorders?
As those conditions are listed in the Diagnostic and Statistical Manual for Mental Disorders, carriers of group health plans must provide coverage for medically necessary treatment of those conditions.