Insights

Revised Coverage Requirements Related to Mental Health and Substance Use Disorder


Effective for health insurance policies issued on or after January 1, 2021, SB 291 revises the coverage requirements related to mental health and substance use disorder. Previously, if an insurer could demonstrate its total anticipated costs for treatment for mental illness would exceed 2% of the total costs for such plan in any experience period, then the insurer could apply necessary cost containment measures, including limitations on inpatient and outpatient benefits, to maintain costs below 2% of the total costs for the plan. The new legislation removes this provision and more closely matches the state’s requirements with those under the ACA.

Insurers are required to provide coverage for the prevention of, screening for, and treatment of behavioral health, mental health and substance use disorder (including autism) that is no less extensive than the coverage provided for any physical illness. Treatment must be in parity in with nonquantitative treatment limitations, financial requirements and quantitative treatment limitations.

Coverage must include screening for unhealthy alcohol use for adults, substance use for adults and adolescents, and depression screening for adolescents and adults.

SB291 »