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Evaluating State Mental Health and Addiction Parity Statutes: A Technical Report 24 5. How are mental health conditions and/or substance use disorders defined in state statutes? (10 points available; only one answer may be selected) a. Includes all disorders listed in Diagnostic and Statistical Manual of Mental Disorders (DSM) or behavioral health disorders in International Classification of Diseases (ICD) (10 points) b. Includes all disorders in DSM or behavioral health disorders in ICD with select exclusions (e.g., caffeine, nicotine, marital problems) (8 points) c. In a list that itemizes a limited number of behavioral health conditions OR includes everything in DSM/ICD with select major exclusions (e.g., depression, substance use disorders) (4 points) d. Includes a specific definition, but without explicit reference to DSM or ICD (2 points) e. Not defined (0 points) It is important that state codes define mental illnesses and substance use disorders in a way that is consistent with modern science, especially since the Federal Parity Law leaves the definition to the states. The gold standard and most inclusive definition is to defer to the DSM or ICD without exception. 6. Does a state statute expressly require coverage of any of the following behavioral health and/or substance use disorder benefits in any type of plan? (10 points available; select all answers that apply) a. Outpatient visits (2 points) b. Inpatient days (2 points) c. Residential mental health or substance use disorder treatment (2 points) d. Medication Assisted Treatment (MAT ) (2 points) e. Emergency medication without prior authorization (2 points) This question seeks to reward states that explicitly require coverage of specific services that are often excluded when not explicitly mentioned, like residential mental health or substance use disorder treatment and emergency medication without prior authorization. It also distinguishes states that seek to confront the opioid epidemic through coverage of MAT. It is important to point out that states that do not expressly require coverage of these services in their statutes may still require coverage. However, since specific benefits are not expressly stated, plans in these states may have more leeway to deny coverage due to lack of specificity for certain benefits. In states where plans denied coverage for residential treatment, the statute remedied this problem by explicitly requiring coverage for residential treatment.

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