The federal Mental Health Parity and Addictions Act did not define mental illness, mental health conditions, or substance abuse disorder. Rather, it explicitly left these definitions up to the terms of insurance plans and applicable federal and state laws.
I’ve put this language below in blue.
Mental health benefits The term “mental health benefits” means benefits with respect to services for mental health conditions, as defined under the terms of the plan and in accordance with applicable Federal and State law.
Substance use disorder benefits The term “substance use disorder benefits” means benefits with respect to services for substance use disorders, as defined under the terms of the plan and in accordance with applicable Federal and State law.
That language can be found at 29 U.S. Code Section 1185(e)(4)-(5) which is available here.
That gap in definition either requires clarity in the Montana law or it will be generally left to the determination of insurance companies or the potential applications of tangential federal laws that were not focused on mental health and addiction parity.
With that in mind, Representative Bishop’s House Bill 142 includes explicit definitions of “mental illness” and “substance abuse” to make it clear what these conditions are and why they need to be fully covered in Montana insurance plans.
Those two definitions are in blue below.
(4)(3) (a) “Mental illness” means a clinically significant behavioral or psychological syndrome or pattern that occurs in a person and that is associated with:
(i) present distress or a painful symptom;
(ii) a disability or impairment in one or more areas of functioning; or
(iii) a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.
(b) Mental illness must be considered as a manifestation of a behavioral, disturbance in an individual’s cognition, emotional regulation, or behavior that reflects a psychological, or biological dysfunction in the underlying mental functioning of a person, causing distress or disability in social, occupational, or other important activities.
(b) Mental illness includes:
(i) any mental health condition or disorder that falls under any of the diagnostic categories listed in the mental disorders section of the current edition of the International Classification of Diseases or that is listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders;
(iii) a diagnosis of any of the following for a child with autism who is 18 years of age or younger, for whom coverage also must comply with 33-22-515(3) through (5):
(A) autistic disorder;
(B) Asperger’s disorder; or
(C) pervasive developmental disorder not otherwise specified.
(c) Mental illness does not include:
(i) a developmental disorder, except autism; or
(ii) a speech disorder;
(6) (a) “Substance use disorder” means a cluster of cognitive, behavioral, and physiological symptoms indicating that an individual continues using alcohol, drugs, or both despite significant substance abuse-related problems.
(b) Substance use disorder includes any condition or disorder that falls under any of the diagnostic categories listed in the mental disorders section of the current edition of the International Classification of Diseases or that is listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders. Substance use disorder includes but is not limited to impaired control over substance use, social impairment, risky use of substances, tolerance of substances, and withdrawal symptoms when blood or tissue concentrations of a substance decline.
(c) Substance use disorder does not include caffeine or nicotine abuse.
You can read the full text of House Bill 142 at this link.
Please support the Montana Mental Health Parity Act. You can find out how in this video.
Matt Kuntz, J.D.