Mental Health Parity FAQs
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.
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.
The limitation cannot place a greater financial burden on the insured than for access to treatment for a physical health condition.
Yes, section 376.779, RSMo, applies to chemical dependency coverage in HIPAA employer group major medical plans.
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.
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.