Recent changes expanded the scope of mental health parity in the Commonwealth of Massachusetts, which requires insurance companies to cover specified diagnoses on a “nondiscriminatory basis”. This means that copayments, deductibles, coinsurance, unit of service limits- such as hospital days and outpatient visits, and/or annual or lifetime maximums are no greater for mental disorders when compared to physical conditions.
The initial Mental Health Parity Law in Massachusetts covered the following “biologically- based” mental disorders: affective disorder, bipolar disorder, delirium and dementia, major depressive disorder, obsessive-compulsive disorder, panic disorder, paranoia and other psychotic disorders, schizoaffective disorder, schizophrenia, and any other “biologically-based” mental disorders appearing in the most recent edition of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association that are scientifically recognized and approved by the Commissioner of Mental Health in consultation with the Commissioner of the Division of Insurance
As of July 1, 2009, the following diagnoses are also covered: autism, eating disorders, post traumatic disorder, and substance abuse disorders. In addition, the expanded mental health parity law allows the Commissioner of the Department of Mental Health to add a diagnosis to the list of covered illnesses without consulting with the Division of Insurance. For conditions that aren’t covered by parity, for each 12 month period, the insurer must cover a minimum of 60 days of inpatient treatment and 24 outpatient visits.
Not all insurance plans are covered under the expanded Massachusetts Mental Health Parity Law, such as self-insured employer group health plans, so it is important for patients in Massachusetts to check with their specific insurance policy.
The expansion of the Massachusetts Mental Health Parity Law is positive change that will allow many more patients with psychiatric disorders to be fully diagnosed and treated with fewer barriers to care.
Betty Wang, MD