SD41 - Mandated Parity in the Coverage of Mental Disorders
The House Committee on Corporations, Insurance and Banking referred House Bill 1052 to the Special Advisory Commission on Mandated Health Insurance Benefits (Advisory Commission) during the 1998 Session of the General Assembly. Delegate A. Donald McEachin is the patron of House Bill 1052. The Senate Committee on Commerce and Labor referred Senate Bill 430 to the Advisory Commission during the 1998 Session of the General Assembly. Senator R. Edward Houck is the patron of Senate Bill 430. If enacted, the bills would amend and reenact § 38.2-3412.1 of Title 38.2 of the Code of Virginia to require any insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; each corporation providing individual or group accident and sickness subscription contracts; and each health maintenance organization (HMO) providing a health care plan for health care services to provide benefits for inpatient, partial hospitalization, medication management and outpatient treatment of a mental disorder that are not less favorable than benefits for any other illness, condition or disorder that is covered by such policy or contract. However, benefits for treatment of a mental disorder may be different from benefits of other illnesses, conditions, or disorders if such benefits meet the medical criteria necessary to achieve the same outcomes as are achieved by the benefits for any other illness, condition or disorder that is covered by such policy or contract.
Coverage for mental disorders is to be neither different nor separate from coverage for any other illness, condition or disorder for purposes of determining deductibles, benefit year or lifetime durational limits, benefit year or lifetime dollar limits, lifetime episodes or treatment limits, co-payment or coinsurance factors, and benefit year maximum for deductibles and co-payment and coinsurance factors.
The bills do not preclude the undertaking of usual and customary procedures to determine the appropriateness of, and medical necessity for, treatment of mental disorders under this option, provided that all such appropriateness and medical necessity determinations are made in the same manner as those determinations made for the treatment of any other illness, condition or disorder covered by such policy or contract.
The bills define "mental disorder" as all medically recognized mental illnesses, as defined by the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV), as updated from time to time.
The bills do not apply to short-term travel, accident only, limited or specified disease policies or contracts, nor to policies or contracts designed for issuance to persons eligible for coverage under Title XVll of the Social Security Act, known as Medicare, or any other similar coverage under state or federal governmental plans. These bills apply to all insurance policies, subscription contracts, and health care plans delivered, issued for delivery, reissued, or extended on and after July 1, 1998, or at any time thereafter when any term of the policy, contract, or plan is changed or any premium adjustment is made.
The 1999 General Assembly passed Senate Bill 430. The bill was amended prior to passage and before it was signed by the Governor. It will be effective on July 1, 2000. The Chairman of the Senate Committee on Commerce and Labor requested a review of this bill by the Advisory Commission.
The Advisory Commission held a hearing to receive public comments on August 24, 1999, in Richmond. Senator Houck and Delegate McEachin addressed the bills. In addition, comments were received from representatives of the National Alliance for the Mentally Ill, the Medical Society of Virginia, the Psychiatric Society of Virginia, the Washington Area Psychiatric Society, the Virginia Chapter of the International Association of Psychosocial Rehabilitation Services, the Virginia Association of Mental Health and the Richmond Pediatric Society. Also, four private citizens spoke in favor of the bill. Written comments in support of the bill were received from Virginians for Mental Health Equity (VMHE), and the Virginia Chapter of the International Association of Psychosocial Rehabilitation Services. Additionally, the Virginia Association of Health Plans (VAHP), by written comments, addressed the potential cost impact of Senate Bill 430. The Advisory Commission concluded its review on the bills on September 21, 1999.