State Mandates for Treatment 

for Mental Illness and 

Substance Use Disorders

State Mandates for 

Treatment for Mental 

Illness and Substance 

Use Disorders

Gail K. Robinson

Jerome B. Connolly

Melanie Whitter

Candy A. Magaña

State Mandates for Treatment for Mental Illness and Substance Use Disorders iii

Acknowledgments

The authors of this report are Gail K. Robinson, Ph.D., vice president, Community and 

Behavioral Health Practice at Abt Associates, Inc.; Jerome B. Connolly, president, Connolly 

Strategies and Initiatives; Melanie Whitter, senior associate at Abt Associates, Inc.; and 

Candy A. Magaña, research assistant at Abt Associates, Inc. Shelagh Smith, M.P.H., provided 

assistance and guidance as the Government project officer and Jeffrey Buck, Ph.D, provided 

direction. Both are with the Center for Mental Health Services (CMHS) at the Substance Abuse 

and Mental Health Services Administration (SAMHSA). Andrew McKinley of Netscan, a former division of the National Conference of State Legislators, also contributed to the development of this report. 

Disclaimer

Material for this report was prepared by Abt Associates, Inc., for SAMHSA, Department of 

Health and Human Services (DHHS), under Contract Number 282-98-0006, Task Order 

No. 47. The content of this publication does not necessarily reflect the views, opinions, or 

policies of CMHS, SAMHSA, or DHHS.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied 

without permission from SAMHSA or CMHS. Citation of the source is appreciated. However, 

this publication may not be reproduced or distributed for a fee without the specific, written 

authorization of the Office of Communications, SAMHSA, DHHS.

Electronic Access and Copies of Publication

This publication can be accessed at http://www.samhsa.gov. For additional free copies of this 

document, please call SAMHSA’s National Mental Health Information Center at 1-800-789-

2647 or 1-866-889-2647 (TTD).

Recommended Citation

Robinson, G., Connolly, J., Whitter, M., & Magaña, C. (2006). State Mandates for Treatment 

for Mental Illness and Substance Use Disorders (DHHS Pub. No. (SMA) 07-4228). Rockville, 

MD: Center for Mental Health Services, Substance Abuse and Mental Health Services 

Administration.

Originating Office

Office of the Associate Director for Organization and Financing, Center for Mental Health 

Services, Substance Abuse and Mental Health Services Administration, One Choke Cherry 

Road, 6-1063, Rockville, MD 20857

DHHS Publication No. (SMA) 07-4228

Printed 2007

State Mandates for Treatment for Mental Illness and Substance Use Disorders v

Contents

I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

II. Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

III. State Mandated Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

A. History of State Legislative Action on Mental Illness and 

Substance Use Disorders Coverage . . . . . . . . . . . . . . . . . . . . . . 5

Initial Focus on Substance Use Disorders . . . . . . . . . . . . . . . . . 5

Movement to Parity Legislation in the Early 1990s . . . . . . . . . 5

Parity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Laws Approaching Parity Become the Norm in 

State Legislation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

States Revise Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Reversal Continues: States Blame Rising 

Costs on Mandated Benefits . . . . . . . . . . . . . . . . . . . . . . . . 8

B. Federal Mental Health Parity Legislation . . . . . . . . . . . . . . . . . . 14

Influences of the Federal Parity Law . . . . . . . . . . . . . . . . . . . 14

State Legislatures Respond to the Federal Law . . . . . . . . . . . 14

C. Exemptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

States Grant Exemptions from Parity and 

Mandated Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

D. Mental Illness and Substance Use Disorders . . . . . . . . . . . . . . . . 41

States Differentiate Between Coverage for 

Mental Illness and Substance Use Disorders . . . . . . . . . . . 41

IV. State Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

A. State Standards for Mental Health Workers . . . . . . . . . . . . . . . . 45

B. State Standards for Addiction Treatment Workers . . . . . . . . . . . . 46

V. Analysis of Prescriptive Authority in the States . . . . . . . . . . . . . . . . . . . . 47

A. Psychiatrists and Psychologists . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

B. Advanced Practice Nurses and Physician Assistants . . . . . . . . . . 47

C. State Actions on Psychotropic Drugs in Schools . . . . . . . . . . . . . 56

VI. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
vi Special Report

List of Exhibits

Table 1: Early Trends in State Law Mandating Behavioral 

Health Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Table 2.a: Chronology of State-Legislated Benefits by Year . . . . . . . . . . . . . 10 

Table 2.b: Chronology of State-Legislated Benefits by State . . . . . . . . . . . . . 12 

Table 3: Mental Illness and Substance Use Disorders Coverage 

Mandated by States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 

Table 4: Exemptions Based on Size of Employer . . . . . . . . . . . . . . . . . . . . 40 

Table 5: Exemptions Based on Premium Increases . . . . . . . . . . . . . . . . . . . 40 

Table 6: States Requiring Parity or Mandating Minimum Benefits—

Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 

Table 7: States Requiring Parity or Mandating Minimum Benefits—

Substance Use Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 

Table 8: Advanced Practice Titles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 

Table 9: Advanced Practice Nurses—Prescriptive Authority . . . . . . . . . . . . 49 

Table 10: Where Physician Assistants Are Authorized to Prescribe . . . . . . . 53

Table 11: Psychotropic Drugs—Prohibitions on School Employees . . . . . . 56 
I. Introduction

1. State-mandated benefits for mental 

illness and substance use disorders 

This section identifies States that require 

insurance companies to provide coverage for 

their insurees who have mental or substance 

use disorders. It also describes the type of 

coverage and diagnostic conditions to which 

the insurance applies. Typically, States use 

one of three methods to require insurance 

companies to cover behavioral health 

conditions:

■ Mandated offering. Coverage that requires 

insurers to provide equal mental and 

physical health benefits if the insurers 

choose to offer coverage for behavioral 

health conditions.

■ Mandated benefits. Coverage that requires 

insurance for specific behavioral health 

conditions. 

■ Parity. Coverage that requires insurance 

for behavioral health conditions equal to 

insurance provided for physical health 

conditions. 

The tables in this section distinguish 

between these three types of insurance 

coverage.

2. State laws regulating behavioral 

health care workers

Behavioral health services are provided by 

a variety of mental health and addiction 

treatment professionals, many of whom are 

licensed or certified at the State level. The 

term “behavioral” in this report refers to 

mental conditions and substance use disorders. This section describes how States 

authorize them to practice subject to State 

licensure and/or certification standards. 

3. Analysis of State-recognized 

prescriptive authority for 

psychotropic drugs

This section analyzes State-recognized prescriptive authority for psychotropic medication. A related section discusses jurisdictions 

that have considered or enacted legislation 

prohibiting school employees from requiring 

or recommending psychotropic drugs for 

children.

State Mandates for Treatment for Mental Illness and Substance Use Disorders 1

The purpose of this report is to describe the current status of Statemandated insurance coverage for mental and substance use disorders, and to identify trends in this type of coverage. The report is 

organized into three main topics: State-mandates benefits; State laws regulating mental health and addiction treatment workers; and those workers’ 

prescriptive authority to prescribe psychotropic medication.

1. State-mandated benefits for 

behavioral health care 

The information on State-mandated benefits 

for behavioral health coverage relies on an 

analysis of State laws conducted by the 

Health Policy Tracking Service, a division of 

Netscan, formerly affiliated with the National Conference of State Legislators, which has 

been tracking State legislative developments 

with respect to behavioral health coverage 

requirements for several years. 

This information was supplemented by a 

State-by-State review of more recently passed 

or amended statutes, which enabled a comparison of behavioral health laws from a 

chronological as well as a content perspective. A review of law and regulation reveals 

the myriad ways States have elected to 

address insurance coverage specifically for 

mental illness and substance use disorders, 

including inpatient and outpatient scope of 

benefits, copay amounts, coinsurance 

requirements, and annual and lifetime dollar 

limits, all in comparison with the same categories for physical illness. 

In addition, the report required an 

analysis of the types of coverage required 

by States with respect to mental and substance use disorders, including the coverage 

definitions referred to above and the various 

limits, qualifications, and exemptions 

employed by States.

2. State laws regulating behavioral 

health care workers

State laws and regulations regarding qualified mental health and addiction treatment 

workers were identified using Lexis-Nexis®. 

Relevant information regarding licensure; 

regulation; scope of practice, including prescriptive authority; and mental health and 

addiction treatment professionals was also 

obtained from professional organizations 

and Web sites.

3. Analysis of State-recognized 

prescriptive authority for 

psychotropic drugs

State laws and regulations granting prescriptive authority to specified mental health 

and addiction professionals were identified 

using Lexis-Nexis®. In addition, any relevant 

information regarding prescriptive authority 

and related scope of practice issues was 

obtained from professional organizations 

and Web sites.

Methodology

This report was compiled in the second half of 2004. A review and 

analysis of existing State laws since the early 1970s was conducted 

to provide the background and context for examining State choices 

in mandating insurance coverage for behavioral health. In 2007, only the 

section on prescriptive authority was updated.

II.

State Mandates for Treatment for Mental Illness and Substance Use Disorders 3

A. History of State Legislative Action 

on Mental Illness and Substance Use 

Disorders1

 Coverage

Initial Focus on 

Substance Use Disorders

State legislation has been used to require 

insurers to provide coverage for specific 

health conditions. Coverage of mental illness 

and substance use disorders was considered 

by legislatures more than 30 years ago when, 

in 1974, California passed a mandated offering bill on mental illness. In 1979, Alabama, 

Mississippi, and South Dakota enacted legislation requiring health insurers (group health 

insurers and health maintenance organizations (HMOs)) to cover 30 days of treatment 

for alcoholism. 

In the early 1980s, additional States, primarily in the South, passed mandated benefit

or mandated offering laws on substance use 

disorders. In the mid- to late-1980s, three 

other jurisdictions—Ohio, Washington, and 

Hawaii—enacted legislation on substance use 

disorders similar to California’s mandated 

offering statute for mental illness. Despite 

activity around mental health issues in a few 

States, the majority of legislative activity in 

the 1970s and 1980s related to substance use 

disorders, specifically alcoholism. During this 

period, 10 States enacted mandated offering

laws for substance use disorders, and 7 

passed legislation requiring substance use 

disorders benefits (Table 1). 

Movement to Parity Legislation 

in the Early 1990s

Parity legislation requires equal coverage for 

physical and mental illnesses. Another 

approach States may take is to require mandated benefits for certain conditions. A third 

type, or mandated offering, requires insurers 

to provide equal mental and physical benefits 

only if they choose to offer coverage of such 

behavioral health conditions. Examples of 

each type of State legislation are described in 

States listed below.

Vermont, Kansas, and Alabama provide 

perhaps the clearest examples of these types 

of legislative requirements. Alabama is considered a mandated offering State, as it 

requires health care service plans and health 

maintenance organizations to treat mental 

and physical illnesses equally if the insurers 

choose to offer coverage of such behavioral 

health conditions. Kansas is a mandated 

benefit State, as State law requires insurers 

to provide coverage for substance use 

disorders and mental illness, and the minimum inpatient and outpatient coverage is 

specified. Perhaps the strongest parity law 

among the States is that of Vermont, which 

requires equal coverage for physical and 

mental illness (including substance use 

disorders). 

State Mandated 

Benefits

III.

State Mandates for Treatment for Mental Illness and Substance Use Disorders 5
6 Special Report

Parity

During the 1990s, States increased enacting 

mental health parity legislation rather than 

focusing on mandated benefits for treatment 

of substance use disorders and alcoholism 

provisions. In 1991, North Carolina and 

Texas were at the forefront of this trend 

when the first parity statutes requiring equal 

insurance coverage for mental and physical 

illnesses became law in those States. Before 

that year, no jurisdiction had required parity 

coverage. These two States applied the law’s 

requirements to limited populations, however, 

targeting benefits to those insured through 

the State employee health plan.

In 1993, Maryland did not pass comprehensive parity legislation, but enacted a mandated 

benefit law for mental illness and substance 

use disorders that included similar provisions.

The statute prohibited any contract providing 

health care benefits from discriminating 

against people with mental illness, emotional 

disorders, or substance use disorders, and 

required insurers to cover treatment and diagnosis of those conditions under the same 

terms applied to physical illness.

Laws Approaching Parity Become the Norm 

in State Legislation

By 1996, the number of States following the 

trend toward parity laws had more than doubled with the addition of mandated mental 

health benefits in New Hampshire and Rhode 

Island (1994), mental illness and substance 

use disorders parity in Minnesota, an amendment to an existing limited parity law in 

Maine (1995), and legislative resolutions 

requiring a study of the issue in Louisiana 

and Oklahoma (1996). 

Legislatively, 1997 was a landmark year 

for State action on this issue. Governors in

Arkansas, Colorado, Connecticut, and 

Table 1. Early Trends in State Law Mandating Behavioral 

Health Coverage

Year State Mandated offering or mandated benefit Type

1974 CA Mandated offering Mental illness

1975 MS Mandated benefit Alcoholism

1979 AL Mandated offering Alcoholism

1979 SD Mandated offering Alcoholism

1980 KY Mandated offering Alcoholism

1981 OR Mandated offering Alcoholism

1981 TX Mandated benefit Substance use disorders

1982 LA Mandated offering Substance use disorders

1982 TN Mandated offering Substance use disorders

1984 ME Mandated benefit Substance use disorders

1985 NJ Mandated benefit Alcoholism

1985 NC Mandated offering Substance use disorders

1985 OH Mandated benefit/mandated offering Alcoholism/Mental illness

1986 MN Mandated benefit Substance use disorders

1987 AR Mandated offering Substance use disorders

1987 NM Mandated offering Alcoholism

1987 WA Mandated offering Mental illness

1988 HI Mandated benefit Mental illness

1989 PA Mandated benefit Substance use disorders

1991 MA Mandated benefit Alcoholism
State Mandates for Treatment for Mental Illness and Substance Use Disorders 7

Vermont signed bills requiring parity in 

health insurance coverage between mental 

illness and physical conditions. The Vermont 

law, which included treatment for alcohol 

and substance use disorders, is still considered by many to be the most comprehensive 

law in the country. 

Bills in 11 other States—Arizona, Delaware, Indiana, Kansas, Louisiana, Montana, 

Nevada, North Carolina, South Carolina, 

Tennessee, and West Virginia—were enacted 

to comply with the Federal Health Insurance 

Portability and Accountability Act. These 

measures included limited mandates comparable to those enacted by Congress in 1996. 

While the laws required insurers to offer 

additional benefits, they did not mandate 

full parity.

Around the same time, North Carolina 

enacted a statute that applied only to the 

teachers’ and State employees’ comprehensive 

major medical plan. This measure expanded 

the State’s existing parity law to include substance use disorders benefits. 

In 1998, Delaware enacted a statute 

requiring parity insurance coverage between 

mental health services and other medical 

treatment, Tennessee passed a minimum mandated benefit for mental health, and South 

Dakota enacted limited parity legislation that 

required equal coverage for biologically 

based mental illnesses and all other illnesses.

The following year was also a momentous 

one for State legislation on these issues: 11 

more States enacted bills. In 1999, Virginia 

adopted a mental health parity law, and 10 

States followed its lead: bills were signed in 

Montana (equal coverage for biologically 

based or serious mental illnesses), New Jersey 

(limited parity), Oklahoma (mandated benefit), Nebraska (mandated offering), Hawaii 

(full parity for three serious mental illnesses), 

Nevada (limited mandated benefit), Connecticut (expansion of an existing parity law), 

Missouri (limited mandated benefit), Louisiana (limited parity), South Dakota (clarification of “biologically based mental illnesses”), 

and California (full parity for severe mental 

illnesses).

By 2000, 19 States had adopted some 

parity legislation for either mental illness, 

substance use disorders, or both. New Mexico enacted legislation requiring group health 

plans to provide both medical/surgical and 

mental health benefits, Massachusetts passed 

a mental health parity bill and a limited mandated benefit for substance use disorders, and 

South Carolina adopted a law requiring equal 

benefits for mental illness treatment and substance use disorders for State employees covered under the jurisdiction’s health insurance 

plans. Alabama, Kentucky, and Utah enacted 

mandated offering laws.

In 2001, Arkansas was added to the list of 

“parity” States by passing legislation requiring equal treatment for mental health care 

covered by ARKids First, its Children’s 

Health Insurance Program (CHIP). Illinois 

enacted a law that required full parity benefits for serious mental illness and minimum 

mandated benefits for other mental conditions. Delaware expanded its mental health 

parity statute to include substance use 

disorders. 

During the same year, Maine adopted legislation requiring several State departments to 

study potential cost savings resulting from 

legislation requiring parity coverage for mental disorders, eating disorders, and substance 

use disorders. Oregon opted to create a joint 

interim task force to examine and make recommendations on achieving parity between 

mental and physical health benefits in insurance plans. 
8 Special Report

Kansas passed a bill requiring group 

health insurance plans, including HMOs that 

provided coverage for mental health benefits 

for the diagnosis and treatment of mental illnesses. It also mandated that the plans provide the same deductibles, coinsurance, and 

other limitations for mental and physical 

conditions.

Also in 2001, Mississippi enacted a law 

that required small employer plans to offer 

coverage for mental health treatment, and 

compelled large employers to provide benefits 

for mental health treatment. Indiana added a 

substance use disorders parity provision, if 

treatment was needed in conjunction with 

mental illness, to the State employee health 

plans, while Rhode Island expanded the definition of mental illness and passed minimum 

mandated benefit laws establishing maximum 

allowable limits on outpatient services. 

States Revise Laws

Despite large increases in parity legislation 

in 2001, the year also signaled the first 

signs of revisions in the States. Perhaps the 

first indicator was when Texas legislators 

amended coverage provided to State 

employees to reduce benefits from full parity 

for serious mental illness to a minimum 

mandated benefit, and set limitations on 

inpatient and outpatient treatment. Despite 

these changes, however, the law continued 

to allow unlimited lifetime benefits, and set 

copayments, coinsurance, and annual limits 

equal to those for physical illness.

In 2002, State actions around parity legislation were mixed. While many legislatures 

considered parity bills with 28 States debating bills, only 8 of them adopted statutes. 

Alabama, Colorado, Maryland, Michigan, 

New Hampshire, and West Virginia passed 

expansive legislation, while Kentucky and 

New Jersey enacted laws that contained mitigating or compromising provisions. The most 

far-reaching of the measures was the parity 

law adopted in West Virginia. 

Legislation in other States further circumscribed the breadth of existing parity laws. 

Kentucky increased by 1 (from 50 to 51 

employees) the size of a company whose 

group health plan would be exempt from 

the mental illness parity requirement. New 

Jersey passed mental illness and substance 

use disorders provisions that applied only to 

plans that offered coverage for individuals. 

This law did not replace existing laws that 

required more extensive coverage, such as 

for group plans and State employee insurance, but instead stipulated the minimum 

scope of inpatient and outpatient benefits 

for individuals insured if the health plan 

offered coverage for biologically based 

mental illnesses and substance use disorders. 

The intent of the New Jersey statute was to 

provide individuals with a less expensive 

option than those offered by group policies.

Reversal Continues: States Blame Rising Costs 

on Mandated Benefits

In 2003, small employers began to assert that 

the steady rise in insurance costs was preventing them from offering additional coverage. They also asserted that a contributing 

factor was the increasing number of required 

benefits. In response, legislators began considering and enacting legislation that waived 

or provided exemptions from State mandates 

This action allowed insurers to offer reduced 

or “bare-bones” health insurance policies. 

That year, four States—Colorado, 

Montana, South Dakota, and Texas—

enacted legislation that allowed the sale of 

less expensive insurance policies that did not 

contain State-mandated benefits. Those laws 

eliminated previous requirements for mental 

illness and substance use disorders treatment. 
State Mandates for Treatment for Mental Illness and Substance Use Disorders 9

In addition, Colorado and Maryland adopted legislation requiring a study and reassessment of the cost of existing mandates, 

including behavioral health requirements. 

In contrast, other States (Maine, Indiana, 

and North Dakota) continued to enact farreaching legislation. Kansas and Hawaii 

amended or deleted the sunset clauses in 

their mental health benefit statutes, allowing 

those laws to continue.

In 2004, a more precipitous decline 

occurred in legislative activity considering 

parity bills. The drop can be attributed either 

to success (32 States had enacted parity and/

or mandated benefits legislation); or suspicion (required benefits were suspected of 

increasing health insurance costs).

Law-making activity in 2003 and 2004 

reflected a concern for, and analysis of, the 

role that mandated benefits had on insurance 

premium costs. For example, a statute enacted in Louisiana exempted health insurers 

from delivering, issuing, or renewing a health 

policy that included any additional or 

required mandated benefit from January 1, 

2004, until December 31, 2008. The State 

also passed legislation allowing insurers or 

HMOs to offer “health flex benefit policies” 

(a type of “bare-bones” coverage) to small 

employers. These plans were not required to 

include State-mandated benefits.

In 2004, several State legislatures considered and passed laws creating exceptions to 

parity and/or mandated benefits, similar to 

the law adopted in Texas in 2001. For example, Kentucky enacted legislation that created 

a 3-year moratorium on (prohibiting the 

adoption of any new) mandated benefits and 

allowed insurers the option of declining from 

offering any additional State-mandated benefits through December 31, 2007. Washington 

adopted a statute permitting insurers to offer 

small employers policies featuring limited 

benefits. These plans did not include coverage for numerous services, such as mental 

health and chemical dependency treatment.

In the same year, legislators in Kentucky 

considered but did not pass legislation that 

would have permitted insurers to offer a catastrophic health benefit plan that excluded 

coverage of any or all State mandates. Washington legislators discussed but did not pass a 

measure that would have allowed insurers to 

offer small employers a stripped-down policy. 

The policy was not required to provide coverage for psychological and other services as 

long as there was disclosure, meaning purchasers were informed of the limitation in 

advance. 

As 2005 began, the movement away from 

sweeping parity legislation was expected to 

continue. Nevertheless, prospects for legislation seemed likely in Iowa and Washington. 

Table 2.a depicts the chronological development of State legislation with respect to parity from 1995 to 2005. Table 2.b displays the 

same information alphabetically, by State.
10 Special Report

Table 2.a. Chronology of State-Legislated Benefits by Year

State Year Type Terms and conditions

North Carolina 1991 Parity Mental illness

Texas 1991 Parity Mental illness

Maryland 1993 Mandated benefit Mental illness

Substance use disorders

Minnesota 1994 Parity Mental illness

Substance use disorders

New Hampshire 1994 Mandated benefit Mental illness

Rhode Island 1994 Mandated benefit Mental illness

Maine 1995 Parity Amendment

Louisiana 1996 Parity Study

Oklahoma 1996 Parity Study

Alaska 1997 Mandated offering Federal Mental Health Parity Act

Arizona 1997 Mandated offering Federal Mental Health Parity Act

Arkansas 1997 Parity Mental illness

Colorado 1997 Parity Mental illness

Connecticut 1997 Parity Mental illness

Delaware 1997 Mandated offering Federal Mental Health Parity Act

Indiana 1997 Mandated offering Federal Mental Health Parity Act

Kansas 1997 Mandated offering Federal Mental Health Parity Act

Louisiana 1997 Mandated offering Federal Mental Health Parity Act

Montana 1997 Mandated offering Federal Mental Health Parity Act

Nevada 1997 Mandated offering Federal Mental Health Parity Act

North Carolina 1997 Parity Substance use disorders 

Applied to State employees plan

North Carolina 1997 Mandated offering Federal Mental Health Parity Act

South Carolina 1997 Mandated offering Federal Mental Health Parity Act

Tennessee 1997 Mandated offering Federal Mental Health Parity Act

Vermont 1997 Parity Mental illness 

Substance use disorders

West Virginia 1997 Mandated offering Federal Mental Health Parity Act

Delaware 1998 Parity Mental illness

South Dakota 1998 Parity Mental illness

Tennessee 1998 Mandated benefit Mental illness

California 1999 Parity Mental illness

Connecticut 1999 Parity Mental illness (expansion)

Hawaii 1999 Parity Mental illness

Louisiana 1999 Parity Mental illness

Missouri 1999 Mandated benefit Mental illness

Montana 1999 Parity Mental illness

Nebraska 1999 Mandated offering Mental illness

Nevada 1999 Mandated benefit Mental illness

New Jersey 1999 Parity Mental illness

Oklahoma 1999 Mandated benefit Mental illness

South Dakota 1999 Parity Clarification

Virginia 1999 Parity Mental illness

Alabama 2000 Mandated offering Mental illness

Kentucky 2000 Mandated offering Mental illness

Substance use disorders

Massachusetts 2000 Parity Mental illness

New Mexico 2000 Mandated benefit Mental illness

South Carolina 2000 Parity Mental illness

Substance use disorders

Applied to State employees plan

Continued
State Mandates for Treatment for Mental Illness and Substance Use Disorders 11

Table 2.a. Chronology of State-Legislated Benefits by Year, continued

State Year Type Terms and conditions

Utah 2000 Mandated offering Mental illness

Arkansas 2001 Parity Mental illness (expansion to CHIP)

Delaware 2001 Parity Substance use disorders 

Added to parity laws

Illinois 2001 Parity Mental illness

Indiana 2001 Parity Substance use disorders 

Applied to State employees plan

Kansas 2001 Mandated offering Mental illness

Mississippi 2001 Mandated benefit Mental illness

Rhode Island 2001 Mandated benefit Mental illness (expansion)

Texas 2001 Mandated benefit Applied to State employees plan

Retrenchment

Alabama 2002 Mandated offering Mental illness (expansion)

Kentucky 2002 Mandated offering Retrenchment

Maryland 2002 Mandated benefit Mental illness

Substance use disorders (expansion)

New Hampshire 2002 Mandated benefit Substance use disorders 

Added to parity laws

New Jersey 2002 Mandated offering Mental illness

Substance use disorders

Retrenchment

West Virginia 2002 Parity Mental illness

Substance use disorders

Colorado 2003 Mental illness

Substance use disorders

Retrenchment

Bare-bones policies without mandated benefits

Hawaii 2003 Extended sunset date

Indiana 2003 Mandated offering Substance use disorders 

Added to parity laws

Kansas 2003 Extended sunset date

Maine 2003 Parity Substance use disorders 

Added to parity laws

Michigan 2003 Mandated benefit Mental illness

Substance use disorders

Montana 2003 Mental illness

Substance use disorders

Retrenchment

Bare-bones policies without mandated benefits

North Dakota 2003 Mandated benefit Mental illness

Substance use disorders

Expansion of existing parity statute

South Dakota 2003 Mental illness

Substance use disorders

Retrenchment

Bare-bones policies without mandated benefits

Texas 2003 Mental illness

Substance use disorders

Retrenchment

Bare-bones policies without mandated benefits

Kentucky 2004 Moratorium

Washington 2004 Bare-bones policies without mandated benefits
12 Special Report

Table 2.b. Chronology of State-Legislated Benefits by State

State Year Type Terms and conditions

Alabama 2000 Mandated offering Mental illness

Alabama 2002 Mandated offering Mental illness (expansion)

Alaska 1997 Mandated offering Federal Mental Health Parity Act

Arizona 1997 Mandated offering Federal Mental Health Parity Act

Arkansas 1997 Parity Mental illness

Arkansas 2001 Parity Mental illness (expansion to CHIP)

California 1999 Parity Mental illness

Colorado 1997 Parity Mental illness

Colorado 2003 Mental illness

Substance use disorders

Retrenchment

Bare-bones policies without mandated benefits

Connecticut 1997 Parity Mental illness

Connecticut 1999 Parity Mental illness (expansion) 

Delaware 1997 Mandated offering Federal Mental Health Parity Act

Delaware 1998 Parity Mental illness

Delaware 2001 Parity Substance use disorders 

Added to parity laws

Hawaii 1999 Parity Mental illness

Hawaii 2003 Extended sunset date

Illinois 2001 Parity Mental illness

Indiana 1997 Mandated offering Federal Mental Health Parity Act

Indiana 2001 Parity Substance use disorders 

Applied to State employees plan

Indiana 2003 Mandated offering Substance use disorders 

Added to parity laws

Kansas 1997 Mandated offering Federal Mental Health Parity Act

Kansas 2001 Mandated offering Mental illness

Kansas 2003 Extended sunset date

Kentucky 2000 Mandated offering Mental illness

Substance use disorders

Kentucky 2002 Mandated offering Retrenchment

Kentucky 2004 Moratorium

Louisiana 1996 Parity Study

Louisiana 1997 Mandated offering Federal Mental Health Parity Act

Louisiana 1999 Parity Mental illness

Maine 1995 Parity Amendment

Maine 2003 Parity Substance use disorders 

Added to parity laws

Maryland 1993 Mandated benefit Mental illness

Substance use disorders

Maryland 2002 Mandated benefit Mental illness

Substance use disorders (expansion)

Massachusetts 2000 Parity Mental illness

Michigan 2003 Mandated benefit Mental illness

Substance use disorders

Minnesota 1994 Parity Mental illness

Substance use disorders

Mississippi 2001 Mandated benefit Mental illness

Missouri 1999 Mandated benefit Mental illness

Montana 1997 Mandated offering Federal Mental Health Parity Act

Montana 1999 Parity Mental illness

Continued
State Mandates for Treatment for Mental Illness and Substance Use Disorders 13

Table 2.b. Chronology of State-Legislated Benefits by State, continued

State Year Type Terms and conditions

Montana 2003 Mental illness

Substance use disorders

Retrenchment

Bare-bones policies without mandated benefits

Nebraska 1999 Mandated offering Mental illness

Nevada 1997 Mandated offering Federal Mental Health Parity Act

Nevada 1999 Mandated benefit Mental illness

New Hampshire 1994 Mandated benefit Mental illness

New Hampshire 2002 Mandated benefit Substance use disorders 

Added to parity laws

New Jersey 1999 Parity Mental illness

New Jersey 2002 Mandated offering Mental illness

Substance use disorders

Retrenchment

New Mexico 2000 Mandated benefit Mental illness

North Carolina 1991 Parity Mental illness

North Carolina 1997 Parity Substance use disorders

Applied to State employees plan

North Carolina 1997 Mandated offering Federal Mental Health Parity Act

North Dakota 2003 Mandated benefit Mental illness

Substance use disorders

Expansion of existing parity statute

Oklahoma 1996 Parity Study

Oklahoma 1999 Mandated benefit Mental illness

Rhode Island 1994 Mandated benefit Mental illness

Rhode Island 2001 Mandated benefit Mental illness (expansion)

South Carolina 1997 Mandated offering Federal Mental Health Parity Act

South Carolina 2000 Parity Mental illness

Substance use disorders

Applied to State employees plan

South Dakota 1998 Parity Mental illness

South Dakota 1999 Parity Clarification

South Dakota 2003 Mental illness

Substance use disorders

Retrenchment

Bare-bones policies without mandated benefits

Tennessee 1997 Mandated offering Federal Mental Health Parity Act

Tennessee 1998 Mandated benefit Mental illness

Texas 1991 Parity Mental illness

Texas 2001 Mandated benefit Applied to State employees plan

Retrenchment

Texas 2003 Mental illness

Substance use disorders

Retrenchment

Bare-bones policies without mandated benefits

Utah 2000 Mandated offering Mental illness

Vermont 1997 Parity Mental illness

Substance use disorders

Virginia 1999 Parity Mental illness

Washington 2004 Bare-bones policies without mandated benefits

West Virginia 1997 Mandated offering Federal Mental Health Parity Act

West Virginia 2002 Parity Mental illness

Substance use disorders
14 Special Report

B. Federal Mental Health Parity 

Legislation

Influences of the Federal Parity Law

While States were grappling with parity legislation and mandated benefits for behavioral 

health issues, the same issues were being discussed and enacted at the Federal level, albeit 

much later.

In 1996, President Bill Clinton signed the 

Mental Health Parity Act, which prohibited 

group health insurers that offered mental 

health benefits from imposing more restrictive annual or lifetime limits on spending for 

mental illness than on physical conditions. 

Because the statute applied only if mental 

health benefits were offered in an insurance 

plan, it was generally considered to be a 

“mandated offering” law. The statute did 

not apply to cost sharing, nor did it include 

substance use disorders conditions. Moreover, employers with fewer than 50 employees could be exempt from the law’s provisions if they expected to experience a 

premium increase of at least 1 percent due 

to the addition of the benefit.

After the law expired in December 2000, 

Congress considered a stronger, more comprehensive mandated offering bill in 2001. 

Despite some success in both chambers, the 

bill failed to survive a House-Senate conference committee. As an alternative, Congress 

extended the 1996 Mental Health Parity Act 

through December 2002. Later, the law was 

extended 1 more year, through December 

2003. During this time, additional attempts 

to pass a mental health parity bill were 

unsuccessful. In the fall of 2003, Congress 

again extended the mental health parity 

statute through December 2005. 

State Legislatures Respond 

to the Federal Law

The 1996 Federal act applies to all insurers 

and prohibits them from imposing annual 

or lifetime dollar limits that are more 

restrictive than those for other illnesses. 

But insurers are not prohibited from restricting office visits and hospital stays. The act 

does not preempt State law, but also does 

not require the States to enact it for it to 

take effect.

Fourteen States have adopted the Federal 

mental health parity (mandated offering) 

statute, and several States that have not 

done so have enacted their own mandated 

offering statute. Thus, most States mandate 

that coverage for mental health must be 

equal to that for physical conditions, if 

mental health coverage is offered. 

In addition, many States have chosen to 

require a combination of coverage requirements. For example, Arkansas, which has 

not adopted the Federal law, mandates parity 

for mental illness yet has enacted mandated 

offering for substance use disorders 

conditions.

Still other States differentiate between 

types of insurance plans when enacting either 

parity or mandated offering requirements. 

For example, Minnesota mandates parity 

for mental illness and substance use disorders for individuals insured by HMOs. In 

contrast, mandated offering applies to those 

same maladies for people who are insured 

in group or individual health plans. 

State statutes include myriad approaches 

to the amount of coverage received by an 

individual, such as the extent of inpatient, 

outpatient, and residential care; the size of 

copays; and allowable annual and lifetime 

dollar limits. Half of the States have elected 

to require the same inpatient and outpatient 
State Mandates for Treatment for Mental Illness and Substance Use Disorders 15

benefits for mental health services as for 

physical illness. In others, day or visit limits 

have been adopted, and a few have specified 

a minimum annual dollar amount for the 

benefit. Slightly fewer States, but still nearly 

half, require parity between the residential 

(inpatient) benefits offered for physical illness and those provided for mental health. 

States handle copayments and deductibles 

in a number of ways. Most (31) require 

the same consideration for physical and 

mental health services.

Table 3 displays the mental illness and 

substance use disorders coverage provisions 

mandated by the States as of December 31, 

2004. States adopting the Federal law and 

those enacting parity provisions of their 

own also are identified. The table also 

includes the scope of inpatient, outpatient, 

and residential benefits, and any provisions 

specifying a lifetime or annual dollar limit 

(compared with that for physical illness). 

Additionally, table 3 presents the 22 States 

that required parity at the end of 2004. Of 

those 22 States, 17 provide general parity, 

while the remainder provide parity for one 

or more of the following categories: serious 

mental illness, developmental disorders, 

biologically based mental illnesses, and 

behavioral health services covered by 

HMOs. In alphabetical order, the “parity” 

States are Arkansas, California, Colorado, 

Connecticut, Delaware, Hawaii, Illinois, 

Maine, Massachusetts, Minnesota, Montana, 

New Hampshire, New Jersey, New Mexico, 

North Carolina, Oklahoma, Rhode Island, 

South Carolina, South Dakota, Vermont, 

Virginia, and West Virginia.
16 Special Report Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness Alabama 1979 No Group and 

HMO

Alcoholism Mandated 

offering

30 days 1 day of inpatient 

treatment converts to 3 sessions of outpatient treatment

1 day of inpatient treatment converts to 2 days of partial/residential treatment

Not specified Not specified

Alabama 2001 No Group and 

individual

Small employers of 50 or fewer

Mental illness

Mandated offering

Must be equal Must be equal Must be equal Must be equal Must be equal

Alabama 2002 No Health care 

service plans and HMOs

Mental illness

Mandated offering

Must be equal Must be equal Must be equal Must be equal Must be equal

Alaska 1997 Yes 

(1997)

Group of 20 employees or fewer must offer coverage

Employers with 5 or fewer employees 

Substance use disorders

Minimum mandated benefits or mandated offering for small groups

Not specified Not specified Not specified Must be equal At least $12,715 

over 2 consecutive years and $25,425 lifetime

Arizona 1998 Yes 

(1997)

Group Small 

employers of 50 or fewer or a premium increase of 1% or more

Mental illness

Mandated offering

Not specified Not specified Not specified Must be equal Must be equal

Arkansas 1987 No Group and 

HMO

Substance use disorders

Mandated offering

Not less favorable, generally

Not less favorable, generally

Not less favorable, generally

Not less favorable, generally

$6,000 every 2 years and $12,000 lifetime

Continued
State Mandates for Treatment for Mental Illness and Substance Use Disorders 17 Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness Arkansas 1997 No Group Small employers of 50 or fewer or a premium increase of 1% or more Mental illness and develop- mental disorders, substance use disorders Parity for mental illness and devel- opmental disorders, mandated offering for chemical dependency Must be equal Must be equal Must be equal Must be equal Must be equal Arkansas 2001 No Employers of 50 or fewer Mental illness Minimum mandated benefits Must be equal (as stated in statute) Must be equal (as stated in statute) Must be equal (as stated in statute) Must be equal $7,500 lifetime Arkansas 2001 No Employers of 51 or more Mental illness Mandated benefit 8 days for larger employers (as stated in statute) 40 visits (as stat- ed in statute) 8 days for larger employers (as stated in statute) Must be equal Must be equal California 1974 No Group Mental illness Mandated offering Not specified Not specified Not specified Not specified Not specified California 1990 No Group Alcoholism Mandated offering Not specified Not specified Not specified Not specified Not specified California 2000 No Group, HMO, and individual Severe mental illness Parity Must be equal Must be equal Must be equal Must be equal Must be equal Colorado 1992 No Group 2003 amendment provides an option for employers of 50 or fewer to purchase plans without a mandate Mental ill- ness with the excep- tion of autism Mandated benefit 45 days Covered under major medical at not less than $1,000 annually 90 days Limited to less than 50% of the total cost of treatment Not less than $1,000 annually; lifetime limits not specified

Continued
18 Special Report Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness

Colorado 1994 No Group 2003 

amendment provides an option for employers of 50 or fewer to purchase plans without a mandate

Alcoholism Mandated 

offering

45 days $500 annually Not specified Limited to less 

than 50% of the total cost of treatment

Not specified

Colorado 1998 No Group 2003 

amendment provides an option for employers of 50 or fewer to purchase plans without a mandate

Biologically based mental illness

Parity Must be equal Must be equal Must be equal Must be equal Must be equal

Connecticut 2000 No Group and 

individual

Mental and nervous conditions, substance use disorders

Parity Must be equal Must be equal Must be equal Must be equal Must be equal

Continued
State Mandates for Treatment for Mental Illness and Substance Use Disorders 19 Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness Delaware 1998 Yes (1997) Group, HMO, individual, and State employee plans Serious mental illness Parity Must be equal Must be equal Must be equal Must be equal Must be equal Delaware 2001 Yes (1997) Group, HMO, individual, and State employee plans Substance use disorders Parity Must be equal Must be equal Must be equal Must be equal Must be equal Florida 1992 Yes (1998) Group and HMO Mental illness Mandated offering 30 days $1,000 per ben- efit year Up to the equiva- lent of 30 days May differ after minimum benefits have been met May differ after minimum ben- efits have been met Florida 1993 Yes (1998) Group and HMO Substance use disorders Mandated offering Not specified 44-visit maximum; $35 maximum reimbursement per visit Not specified Not specified Minimum lifetime benefit of $2,000; annual limits not specified Georgia 1998 No Group and individual Mental illness including substance use disorders Mandated offering 30 days 48 visits Not specified Must be equal Must be equal Hawaii 1988 No Group, HMO, and individual Mental illness Mandated benefits 30 days 30 visits 1 day of inpatient treatment con- verts to 2 days of partial/residential treatment Must be comparable Must be comparable Continued
20 Special Report Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness

Hawaii 1988 No Group, 

HMO, and individual

Substance use disorders

Mandated benefits

No fewer than 2 visits per lifetime

No fewer than 2 visits per lifetime

No fewer than 2 visits per lifetime

Must be comparable

Must be comparable

Hawaii 1999 No Group and 

individual

Employers of 25 or fewer

Serious mental illness

Parity Must be equal Must be equal Must be equal Must be equal Must be equal

Idaho N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Illinois 1991 No Group Mental 

illness

Mandated offering

Not specified Not specified Not specified Individuals may 

be required to pay up to 50% of the expenses

Benefits may be limited to the lesser of $10,000 or 35% percent of the lifetime policy limit.

Illinois 1995 No Group Alcoholism Mandated 

benefits

Not specified Not specified Not specified Not specified Not specified

Illinois 2002 No Group Employers 

of 50 or fewer

Serious mental illness; mental illnesses other than serious mental illnesses

Parity for serious mental illnesses; mandated offering for less severe mental illnesses

Must be equal for serious mental illness; 45 days for less severe mental illnesses

Must be equal for serious mental illness; 35 days for less severe mental illnesses

Must be equal for serious mental illness; not specified for less severe mental illnesses

Must be equal for serious mental illness; 

individuals with less severe mental illness may pay up to 50% of expenses

Must be equal for serious mental illness; annual benefits for less severe mental illnesses may be limited to the lesser of $10,000 or 25% of lifetime policy limit

Indiana 1997 

(sunset dateextended in 2000)

Yes (1997)

Group, HMO, individual, and State employee plans 

Small employers of 50 or fewer or a premium increase of 1% or more

Mental illness

Mandated offering

Must be equal Must be equal Must be equal Must be equal Must be equal

Continued
State Mandates for Treatment for Mental Illness and Substance Use Disorders 21 Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness Indiana 2001 Yes (1997) State employee plans Premium increase of 4% or more Substance use disorders Mandated offering for plans that offer coverage for mental illness Must be equal Must be equal Must be equal Must be equal Must be equal Indiana 2003 Yes (1997) Group, HMO, and individual Substance use disorders Mandated offering for plans that offer coverage for mental illness Must be equal Must be equal Must be equal Must be equal Must be equal Iowa N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Kansas 1998 Yes (1997) Group, HMO, individual, and State employee plans Substance use disor- ders and mental illness Mandated benefits 30 days Not less than 100% of the first $100, 80% of the next $100, and 50% of the next $1,640 per year; not less than $7,500 per lifetime Not specified Not specified Only specified for outpatient treatmentContinued
22 Special Report Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness

Kansas 2002 Yes 

(1997)

Group, HMO, and State employee plans for mental illness; group and individual for substance use disorders or nervous/ mental conditions

Mental illness, substance use disorders, and nervous/mental conditions

Mandated offering for mental illness; mandated benefits for substance use disorders or nervous/mental conditions

45 days for mental illness; 30 days for substance use disorders or nervous/mental conditions

45 visits for mental illness; not less than 100% of the first $100, 80% of the next $100, and 50% of the next $1,640 per year; not less than $7,500 per lifetime for substance use disorder or nervous/mental conditions 

Not specified Equal if offered 

for mental illness; not specified for substance use disorders or nervous/mental conditions

Only specified for outpatient treatment

Kentucky 1980 No Group Alcoholism Mandated 

offering

3 days of emergency detox reimbursed at $40 per day

10 visits reimbursed at $10 per visit

10 days reimbursed at $50 per day

Not specified Not specified

Kentucky 1996 No Group Mental 

illness

Mandated offering

Must be equal Must be equal Not specified Must be equal Must be equal

Kentucky 2000 No Group Small 

employers of 50 or fewer 

Mental illness and substance use disorders

Mandated offering

Equal if offered Equal if offered Equal if offered Equal if offered Equal if offered

Kentucky 2001 No Group Amends the 

law passed in 2000 to exempt employers of 51 or fewer

Continued
State Mandates for Treatment for Mental Illness and Substance Use Disorders 23 Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness Louisiana 1982 Yes (1997) Group Substance use disorders Mandated offering Must be equal Must be equal Must be equal Must be equal Must be equal Louisiana 1982 Yes (1997) Group, self- insured, and State employee plans Mental illness Mandated offering Must be equal Must be equal Must be equal Must be equal Must be equal Louisiana 2000 Yes (1997) Group, HMOs, and State employee plans Serious mental illness Mandated benefits 45 days 52 visits 1 day of inpatient treatment for mental illness is equivalent to 2 days of partial/ residential treatment Must be equal Must be equal Louisiana 2001 Yes (1997) Group Small employ- ers or a premium increase of 1% or more Mental health Mandated offering Not specified Not specified Not specified Not specified Equal if offered Maine 1984 Yes (1997) Group Small employers of 20 or fewer Alcoholism and drug depen- dency (as stated in statute) Mandated benefits Not specified Not specified Not specified May place a maximum limit on benefits provided they are consis- tent with State law May place a maximum limit on benefits pro- vided they are consistent with State law Maine 1996 Yes (1997) Group and individual plans with 20 employ- ees or fewer Biologically based mental illness Mandated offering Must be equal Must be equal Must be equal Must be equal Must be equal Continued
24 Special Report Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness

Maine 1996 Yes 

(1997)

Group and HMOs

Small employers of 20 or fewer

Mental illness

Parity Must be equal Must be equal Must be equal Must be equal Must be equal

Maine 2003 Yes 

(1997)

Group and HMOs 

Small employers of 20 or fewer

Mental illness; expands coverage to 11 categories of mental illness, including substance use disorders

Parity Must be equal Must be equal Must be equal Must be equal Must be equal

Maryland 1994 No Individual 

and group

Mental illness, emotional disorders, substance use disorders

Minimum mandated 

benefit (statutory language; insurer can provide no less)

Must be equal Unlimited visits 60 days Must be equal 

with the exception of outpatient visits; 80% for 1-5 visits, 65% for 6-30 visits, 50% for more than 30 visits

Must be equal

Maryland 2002 No Group and 

individual insurers, HMOs, and nonprofit health service plans 

Residential crisis services defined as intensive mental health and support services

Minimum mandated 

benefit (statutory language; insurer can provide no less)

Not specified Not applicable Not applicable Not specified Not specified

Continued
State Mandates for Treatment for Mental Illness and Substance Use Disorders 25 Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness Massa- chusetts 1991 No Group, HMO, and individual Alcoholism Mandated benefits 30 days $500 annually May convert 2 days of partial/ residential treatment to 1 day of inpatient treatment Not specified Not specified Massa- chusetts 1996 No Group, HMO, and individual Mental and nervous conditions Mandated benefits 60 days in a mental hospital $500 annually May convert 2 days of partial/ residential treatment to 1 day of inpatient treatment Not specified Lifetime maxi- mum must be equal for inpa- tient treatment Massa- chusetts 2001 No Group, HMO, individual, and State employee plans Small employers of 50 or fewer (law states that the exemp- tion expired on 1/1/2002) Biologically based mental illness and related cases; substance use dis- orders; all Diagnostic and Statistical Manual (DSM) diagnoses not cov- ered under parity provisions Parity for biologically based illness- es, mandated benefits for other DSM diagnoses Must be equal for biologically based; 60 days for other DSM diagnoses Must be equal for biologically based; 24 visits for other DSM diagnoses Must be equal Must be equal Must be equal Continued
26 Special Report Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness

Michigan 1998 No Group for 

inpatient; group and individual for other modes of treatment

Premium increase of 3% or more

Substance use disorders

Mandated offering for inpatient and mandated 

benefits for other treatments

To the extent agreed upon

$1,500 annually for outpatient and intermediate treatment

$1,500 annually for outpatient and intermediate treatment

Charges, terms, and conditions shall not be less favorable

$1,500 annually for outpatient and intermediate treatment

Michigan 2001 No Group, 

HMO, and individual

Exemption from substance use disorder service if premiums increase by 3% or more

Mental health and substance use disorders

Minimum mandated benefit

None Not fewer than 

20 visits for mental health and $2,968 for substance use disorders

$2,968 for substance use disorders

Must be equal Lifetime limits 

aren’t specified; $2,968 annually for outpatient and intermediate care for substance use disorders

Minnesota 1986 No Group and 

individual

Substance use disorders

Mandated benefits

At least 20% of the total days allowed but not fewer than 28 days annually

At least 130 hours of treatment annually

At least 20% of the inpatient days allowed but not fewer than 28 days annually

Not specified Not specified

Minnesota 1995 No Group, 

HMO, and individual

Mental illness and substance use disorders

Parity for HMOs; mandated offering for group and individual plans

Must be equal for both

Must be equal for both

Must be equal for both

Must be equal for both

Must be equal for both

Mississippi 1975 No Group Alcoholism Mandated 

benefits

Not specified Not specified Not specified Not specified Annual limit 

of $1,000; lifetime limit not specified

Continued
State Mandates for Treatment for Mental Illness and Substance Use Disorders 27 Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness Mississippi 2002 No Group and individual Premium increase of 1% or more Mental illness Mandated offering for small employ- ers of 100 or fewer and minimum mandated benefits for others 30 days 52 visits 60 days Must be equal for inpatient and partial treatment; outpatient treatment must be a minimum of 50% of covered expenses Must be equal Missouri 1995 No Group and individual Substance use disorders Mandated benefits for alcoholism; mandated offering for chemical dependency 30 days for alcoholism; 80% of reasonable charges; $2,000 maximum 30 total days for all levels of care 30 total days for all levels of care Not specified Not specified Missouri 1997 No Group, HMO, and individual Mental illness and sub- stance use disorders Mandated offering 90 days for men- tal illness and 6 days for detox 2 visits for mental illness and 26 visits for substance use disorders Must be equal for mental ill- ness; 21 days for substance use disorders Must be equal Must be equal for mental ill- ness; substance use disorders may not be limited to fewer than 10 episodes of treatment Missouri 2000 No Group and individual Mental illness including substance use disorders Mandated offering Equal for mental illness; at least 30 days for substance use disorders if offered Equal for mental illness; at least 20 visits for substance use disorders if offered Not specified Shall not be unreasonable in relation to the costs of services provided for mental illness A lifetime limit equal to 4 times the annual limit may be imposed for substance use disorders Continued
28 Special Report Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness

Montana 1997 Yes 

(1997)

Group Small group 

(unspecified number) or a premium increase of 1% or more

Mental illness and substance use disorders

Mandated benefits

21 days each with a $4,000 maximum every 2 years; $8,000 lifetime maximum for substance use disorders

No less than $2,000 for mental illness and $1,000 for substance use disorders annually

1 day of inpatient treatment for mental illness is equivalent to 2 days of partial treatment

No less favorable, up to maximums

Aggregate limits may not be imposed more restrictively

Montana 2000 Yes 

(1997)

Group and individual

Severe mental illness

Parity Must be equal Must be equal Must be equal Must be equal Must be equal

Montana 2001 

(replaces 1997 law)

Yes (1997)

Group Mental 

illness and substance use disorders

Mandated benefits

21 days for mental illness; $6,000 annual limit until $12,000 lifetime limit is met; annual benefits may then by reduced to $2,000 for substance use disorders

Not less than $2,000 for mental illness

1 day of inpatient treatment for mental illness is equivalent to 2 days of partial

No less favorable, up to maximums

Not specified

Nebraska 1989 No Group and 

HMOs

Alcoholism Mandated 

offering

30 days annually with at least 2 treatment periods in a lifetime

60 visits during the lifetime of the policy

Not specified No less favorable, generally, 

than for physical illness

No less favorable, generally, than for physical illness

Nebraska 2000 No Group and 

HMOs 

Small employers of 15 or fewer

Serious mental illness

Mandated offering

Must be equal if offered

Must be equal if offered

Not specified May be different Must be equal if 

offered

Continued
State Mandates for Treatment for Mental Illness and Substance Use Disorders 29 Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness Nevada 1997 Yes (1997) Group, HMO, and individual Substance use disorders Mandated benefits $9,000 inpatient and $1,500 for detox per year $2,500 annually Not specified Must be paid in same manner Must be paid in same manner to maximum benefit; lifetime maximum not specified Nevada 2000 Yes (1997) Group and individual Small employers of 25 or fewer or a premium increase of 2% or more Severe mental illness Mandated benefits 40 days 40 visits 1 day of inpatient treatment for mental illness is equivalent to 2 days of partial/ residential treatment Must not exceed 150% of the out-of- pocket expenses required for medical and surgical care Must be equal New Hampshire 1995 No Group Biologically based mental illness Parity Must be equal Must be equal Must be equal Must be equal Must be equal Continued
30 Special Report Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness

New Hampshire

2003 No Blanket 

accident or health plans, group, HMO, nonprofit health service corporations, and State employee plans 

Biologically based mental illness (amends the list from the 1995 law), substance use disorders, mental illnesses in the DSM other than biologically based illnesses

Parity for biologically based mental illness; minimum mandated benefits for substance use disorders and mental illnesses other than biologically based illnesses

Must be equal for biologically based illness; may be limited for substance use disorders, yet must provide benefits for detoxification and rehabilitation; benefits for mental illness other than biologically based must be equal to benefits provided on a basis other than a major medical basis

Must be equal for biologically based mental illness; benefits for substance use disorders may be limited, yet must include benefits for detoxification and rehabilitation; HMOs that offer benefits must cover 2 diagnostic visits and 3 treatment visits per contract year; for group or blanket insurers, at 15 hours per year 

Must be equal for biologically based illness; not specified for substance use disorders; benefits for other mental illnesses must be equal for residential programs and outpatient services on a basis other than major medical 

Must be equal for biologically based illnesses; not specified for substance use disorders; benefits for other mental illnesses must be equal except for coinsurance and HMOs may not exceed 20% of the reasonable and customary charge

Must be equal for biologically based illness; may be limited for substance use disorders; for other mental illnesses, benefits for inpatient, outpatient and partial hospitalization may be limited to not less than $3,000 annually and $10,000 per lifetime

New Jersey

1985 No Group and 

individual

Alcoholism Mandated 

benefits for care prescribed by a doctor

Must be equal Must be equal Must be equal Benefits shall 

be provided to the same extent as for other illnesses

Benefits shall be provided to the same extent as for other illnesses

New Jersey

1999 No Group and 

individual

Biologically based mental illness

Parity Must be equal Must be equal Must be equal Must be equal Must be equal

Continued
State Mandates for Treatment for Mental Illness and Substance Use Disorders 31 Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness New Jersey 2000 No State employee plans Biologically based mental illness Parity Must be equal Must be equal Must be equal Must be equal Must be equal New Jersey 2002 No Individual Biologically based mental illness and sub- stance use disorders Mandated offering 90 days for mental illness; 30 days total for inpatient and/or outpatient treatment for substance use disorders 30 days for mental illness; 30 total days for inpatient and/or outpatient treatment for substance use disorders Not specified No coinsur- ance for mental illness, yet a $500 copayment per inpatient stay and a 30% coinsurance for outpatient visits; 30% coinsurance for substance use disorders Not specified New Mexico 1987 Yes (1998) Group Alcoholism Mandated offering 30 days annually and no fewer than 2 episodes per lifetime 30 days annu- ally and no fewer than 2 episodes per lifetime Not specified Consistent with those imposed on other benefits Consistent with those imposed on other benefits New Mexico 2000 Yes (1998) Group For employ- ers of 49 or fewer, a premium increase of more than 1.5%; for employers of more than 50, a premium increase of more than 2.5% Mental health benefits as described in the group health plan Parity Must be equal Must be equal Must be equal Must be equal Must be equal

Continued
32 Special Report Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness

New York 1998 No Group Mental 

illness including substance use disorders

Mandated offering

30 days for mental illness and substance use disorders; 7 days for detoxification

$700 for mental illness and 60 visits for substance use disorders

Not specified As deemed 

appropriate by the superintendent and are consistent with those for other benefits

As deemed appropriate by the superintendent and are consistent with those for other benefits

North Carolina

1985 Yes 

(1997)

Group Substance 

use disorders

Mandated offering

$8,000 per year and $16,000 per lifetime

$8,000 per year and $16,000 per lifetime

$8,000 per year and $16,000 per lifetime

$8,000 per year and $16,000 per lifetime

$8,000 per year and $16,000 per lifetime

North Carolina

1997 Yes 

(1997)

State employee plans

Mental illness and substance use disorders

Parity Must be equal Must be equal Must be equal Must be equal Must be equal

North Dakota

1995 No Group and 

HMO

Mental illness and substance use disorders

Mandated benefits

45 days for mental illness and 60 days for substance use disorders

30 hours for mental illness and 20 visits for substance use disorders

120 days for mental illness and substance use disorders

No deductible or copay for the first 5 hours, not to exceed 20% for the remaining hours

Not specified

North Dakota

2003 No Group and 

HMO

Substance use disorders

Mandated benefits (amends the 1995 law)

45 days No change 60 days; if additional treatment 

is required, up to 23 days of unused inpatient treatment may be traded at a rate of 1 inpatient day for 2 residential days

No change No change

Continued
State Mandates for Treatment for Mental Illness and Substance Use Disorders 33 Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness Ohio 1985 No Group and self-insured Mental ill- ness and alcoholism Mandated offering for plans that offer men- tal health coverage; mandated benefits for alcoholism At least $550 annually for mental illness and alcoholism At least $550 annually for mental illness and alcoholism At least $550 annually for mental illness and alcoholism Benefits are sub- ject to reason- able coinsurance and deductibles Lifetime dol- lar limits are unspecified Oklahoma 2000 No Group Small employers of 50 or fewer or a premium increase of 2% or more Severe mental illness Parity Must be equal Must be equal Must be equal Must be equal Must be equal Oregon 1981 No Individual Alcoholism Mandated offering $4,500 in a 24- month period $4,500 in a 24- month period $4,500 in a 24- month period Coverage must be no less than 80% of total expenses Lifetime not specified Oregon 2000 No Group and HMO Mental illness including substance use disorders Mandated benefits $5,625 for adults and $5,000 for children for the treatment of substance use disorders; $5,000 for adults and $7,500 for children per 24- month period for the treatment of mental illness $1,875 for adults and $2,500 for children for the treatment of substance use disorders; $2,500 for adults and children per 24- month period for mental health treatment $4,375 for adults and $3,750 for children for substance use disorder treat- ment; $1,250 for adults and $3,750 for children per 24-month period for mental health treatment Will be no great- er than those for other illnesses For dual diagnosis for mental illness and substance use disorders, $13,125 for adults and $15,625 for children. For substance use disorders only, $8,125 for adults and $13,125 per 24-month period

Continued
34 Special Report Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness

Pennsylvania 1989 No Group and HMO Substance use 

disorders

Mandated benefits

7 days of detoxification per year and 28 per lifetime

30 visits per year and 120 per lifetime

30 visits per year, 90 days per lifetime

For the first course of treatment, will be no greater than those for other illnesses

Dollar limits not specified; day and visit limits as specified for each level of care

Pennsylvania 1999 No Group and HMO Small employers 

of 50 or fewer

Serious mental illness

Mandated benefits

30 days 60 visits; 1 day 

of inpatient may be converted to 2 visits

Not specified May not prohibit access to 

services

Must be equal

Rhode Island

1995 No Group, 

HMO, individual, and self-insured 

Serious mental illness

Parity Must be equal Must be equal Not specified Must be equal Must be equal

Rhode Island

2002 No Group, 

HMO, individual, and self-insured 

Mental illness including substance use disorders

Minimum mandated benefit

Must be equal 30 visits for 

mental illness only; 30 visits for substance use disorders only; five detoxification occurrences or 30 days, whichever comes first

Must be equal Must be equal Must be equal

South Carolina

1994 Yes 

(1997)

Group Mental 

illness including substance use disorders

Mandated offering

$2,000 annual limit

$2,000 annual limit

$2,000 annual limit

May be different $10,000 lifetime 

maximum

Continued
State Mandates for Treatment for Mental Illness and Substance Use Disorders 35 Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness South Carolina 2002 Yes (1997) State employee plans Premium increase of 1% by 12/31/2004 or 3.39% at any time between 1/1/2002 and 12/31/2004 Mental illness and sub- stance use disorders Parity Must be equal Must be equal Must be equal Must be equal Must be equal South Dakota 1979 No Group, HMO, and individual Alcoholism Mandated offering 30 days of care overall each 6 months; 90 days lifetime 30 days of care overall each 6 months; 90 days lifetime 30 days of care overall each 6 months; 90 days lifetime On the same basis as benefits provided for other illnesses On the same basis as benefits provided for other illnesses South Dakota 1998 No Group, HMO, and individual Biologically based mental ill- ness (defi- nition is narrowed by a 1999 amend- ment) Parity Must be equal Must be equal Must be equal Must be equal Must be equal Tennessee 1982 Yes (1997) Group Small employers of 50 or fewer or a premium increase of 1% or more Substance use disorders Mandated offering Must be equal Must be equal Must be equal Must be equal Must be equal Continued
36 Special Report Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness

Tennessee 2000 Yes 

(1997)

Group Small 

employers of 25 or fewer or a premium increase of 1% or more

Mental illness

Mandated benefits

20 days 25 visits 1 day of inpatient 

treatment can be converted to 2 days of partial/residential treatment

Must be equal Must be equal

Texas 1981 No Group and 

self-insured 

Selfinsured plans of 250 or fewer

Substance use disorders

Mandated benefit with a mandated offering for self-insured plans of 250 or fewer

Lifetime maximum of 3 separate series of treatments, including all levels of medically necessary care in each episode

Lifetime maximum of 3 separate series of treatments, including all levels of medically necessary care in each episode

Lifetime maximum of 3 separate series of treatments, including all levels of medically necessary care in each episode

Must be sufficient to provide appropriate care

Must be sufficient to provide appropriate care

Texas 1997 No Group and 

HMO 

Small employers of 50 or fewer

Serious mental illness

Mandated benefit with a mandated offering for small groups of 50 or less (law effective 1/1/04 allows insurers and HMOs to offer policies without this mandate)

45 days 60 visits; medication checks 

are not counted toward this limit

Not specified Must be equal Must be equal

Texas 2001 No State 

employee plans

Serious mental illness

Minimum mandated benefit

45 days 60 visits Not specified Must be equal Not specified; 

annual limits must be equal

Continued
State Mandates for Treatment for Mental Illness and Substance Use Disorders 37 Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness Utah 1994 No Group Substance use disorders Mandated offering Not specified Not specified Not specified Not specified Not specified Utah 2001 (sun- sets in 2011) No Group and HMO Mental illness as defined by the DSM Mandated offering May include restrictions May include restrictions May include restrictions May include restrictions May include restrictions Vermont 1998 No Group, individual, and State employee plans Mental illness including substance use disorders Parity Must be equal Must be equal Must be equal Must be equal Must be equal to achieve the same outcome as treatment for any other illness Virginia 2000 (2004 law deleted sunset provi- sion) No Group and individual Small employers of 25 or fewer Biologically based mental illness, including substance use disorders Parity Must be equal to achieve the same outcome as treatment for any other illness Must be equal to achieve the same outcome as treatment for any other illness Must be equal to achieve the same outcome as treatment for any other illness Must be equal to achieve the same outcome as treatment for any other illness Must be equal to achieve the same outcome as treatment for any other illness Virginia Effec- tive until 1/1/ 2000 and after 7/1/ 2004 No Group, HMO, and individual Mental illness and sub- stance use disorders Mandated benefits 25 days for adults and children 20 visits for adults and children For children, up to 10 days of inpatient treat- ment can be converted at the rate of 1.5 days of partial treatment for 1 day of inpatient treatment Coinsurance for insurance for outpatient treat- ment can be no more than 50% after 5 visits. All others must be equal Benefits shall be no more restrictive than for other ill- nesses except as specified Washington 1987 No Group and HMO Mental illness Mandated offering Not specified Not specified Not specified Not specified Not specified

Continued
38 Special Report Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness

Washington 1988 No Group Substance 

use disorders

Mandated benefits

Not specified Not specified Not specified Not specified Not specified 

West Virginia

1998 Yes 

(1997)

Group Alcoholism Mandated 

offering

30 days Not specified Not specified Must be equal up 

to 30 days. Can not exceed 50% for outpatient

Not less than $750 annually and not less than an amount equal to the lesser of $10,000 or 25% of the lifetime limit

West Virginia

2002 Yes 

(1997)

State employee plans and group accident and sickness plans 

State employee plan premium increase of 2% or more; group accident and sickness plans with a premium increase of 1% or more for plans of 25 or fewer and 2% or more for larger plans

Serious mental illness including substance use disorders

Parity Must be equal Must be equal Must be equal Must be equal Must be equal

Continued
State Mandates for Treatment for Mental Illness and Substance Use Disorders 39 Table 3. Mental Illness and Substance Use Disorders Coverage Mandated by States, continued State Effec­ tive date Adopted Federal parity Affected populations Exemptions to affected population Illnesses covered Type of mandated benefit Scope of inpatient benefits in comparison with benefits for physical illnesses Scope of outpatient benefits in comparison with benefits for physical illness Scope of partial/ residential benefits in comparison with benefits for physical illness Copays and coinsurance in comparison with those for physical illness Lifetime/annual dollar limits in comparison with those for physical illness Wisconsin 2004 No Group or blanket disability insurance Mental illness and sub- stance use disorders Mandated offering Except that the costs of pre- scription drugs and diagnostic tests are exempt from the limits set in the 1985 law, not fewer than the fewer of 30 days or $7,000 minus any cost sharing or, if the policy does not use cost sharing, $6,300 in equiva- lent benefits Except that the costs of pre- scription drugs and diagnostic tests are exempt from the limits set in the 1985 law, not less than $2,000 minus any cost sharing or, if the policy does not use cost sharing, $1,800 in equivalent benefits Except that the costs of pre- scription drugs and diagnostic tests are exempt from the limits set in the 1985 law, not less than $3,000 minus any applicable cost sharing for transitional treat- ment, or, if the policy does not use cost sharing, $2,700 in equiva- lent benefits Except that the costs of pre- scription drugs and diagnostic tests are exempt, may apply the same deduct- ible and/or copayment to behavioral health services that apply to all ben- efits. May apply deductibles, copays, or coin- surance to inpa- tient, outpatient, and transitional services Except that the costs of pre- scription drugs and diagnostic tests are exempt, annual benefits need not exceed $7,000 or the equivalent ben- efits measured in services rendered. The amount may be reduced if the policy is written in combination with major medi- cal coverage Wyoming N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A
40 Special Report

Table 4. Exemptions Based on 

Size of Employer

State Exemptions 

Alabama Small employers of 50 or fewer

Alaska Employers with 5 or fewer employees

Arizona Small employers of 50 or fewer

Arkansas Small employers of 50 or fewer

Colorado Employers of 50 or fewer purchase 

plans without mandate

Hawaii Employers of 25 or fewer

Illinois Employers of 50 or fewer

Kentucky Small employers of 51 or fewer

Louisiana Small employers

Maine Small employers of 20 or fewer

Montana Small group (unspecified number)

Nebraska Small employers of 15 or fewer

Nevada Small employers of 25 or fewer

Oklahoma Small employers of 50 or fewer

Pennsylvania Small employers of 50 or fewer

Tennessee Small employers of 25 or fewer

Texas Self-insured plans of 250 or fewer; 

small employers of 50 or fewer

Virginia Small employers of 25 or fewer

Table 5. Exemptions Based on 

Premium Increases

State Exemptions

Arizona Premium increase of 1 percent or more

Arkansas Premium increase of 1 percent or more

Indiana Premium increase of 4 percent or more

Louisiana Premium increase of 1 percent or more

Michigan Premium increase by 3 percent or more 

allows exemption from substance use 

disorders coverage

Mississippi Premium increase of 1 percent or more

Montana Premium increase of 1 percent or more

Nevada Premium increase of 2 percent or more

New Mexico Premium increase of more than 

1.5 percent (more than 2.5 percent 

for employers of more than 50)

Oklahoma Premium increase of 2 percent or more

South 

Carolina

Premium increase of 1 percent by 

12/31/04 or 3.39 percent at any time 

between 01/01/02 and 12/31/04

Tennessee Premium increase of 1 percent or more

West Virginia Premium increase of 2 percent or more 

for State plans, 1 percent of more for 

group plans, 1 percent or more for plans 

of 25 or fewer employees, and 2 percent 

or more for larger plans

C. Exemptions

States Grant Exemptions from 

Parity and Mandated Benefits

Like the Federal mental health parity statute, many States have placed certain restrictions on, or granted exemptions to, the 

mandated offering requirement. A common 

exemption is one granted to small employers 

(most frequently those with fewer than 50 

employees). Table 4 identifies the triggering 

threshold for this exemption, which some 

States included in their original legislation 

and some elected to add later.

Likewise, many States (13) have adopted 

clauses that waive the mandate (either 

mandated benefits or mandated offering) 

when the premium cost would increase if 

the benefit was added. A one percent rise in 

premium is typically the threshold for triggering the exemption. Table 5 describes, by 

State, the exemptions based on premium 

increases.
State Mandates for Treatment for Mental Illness and Substance Use Disorders 41

Table 6. States Requiring Parity or Mandating Minimum Benefits—

Mental Health

State Condition Requirement

Arkansas Mental illness and developmental 

disorders

Parity for mental illness and developmental disorders

Arkansas Mental illness Parity

California Severe mental illness Parity

Colorado Biologically based mental illness Parity

Connecticut Mental and nervous conditions Parity

Delaware Serious mental illness Parity

Hawaii Serious mental illness Parity

Illinois Serious mental illness Parity for serious mental illnesses

Kansas Mental illness Mandated benefits

Kansas Nervous/mental conditions Mandated benefits

Louisiana Serious mental illness Mandated benefits

Maine Mental illness; expands coverage to 11 

categories of mental illness

Parity

Maryland Mental illness, emotional disorders, 

residential crisis services defined as 

intensive mental health and support 

services

Minimum mandated benefit (statutory language; 

insurer can provide no less)

Massachusetts Biologically based mental illness and 

related cases; all DSM diagnoses not 

covered under parity provisions

Parity for biologically based illnesses, mandated 

benefits for other DSM diagnoses

D. Mental Illness and 

Substance Use Disorders

States Differentiate Between Coverage for 

Mental Illness and Substance Use Disorders

Of the 32 States that mandate some coverage 

of behavioral health conditions, 22 require 

equal treatment for mental illness, defined as 

either biologically based mental illness or 

serious mental illness. In addition, other 

jurisdictions have chosen to require minimum benefits for mental illness and/or substance use disorders. However, most of these 

laws do not require equal treatment for all 

mental illness and substance use disorders. 

Specifically, not only are substance use 

disorders treated differently than physical 

illness, but coverage of the diagnosis is 

required less often than for mental illness. 

Only 9 States have adopted parity statutes 

for substance use conditions, while 18 have 

chosen mandated offering provisions. Twenty 

States require a minimum benefit for substance use disorders, with some States singling out alcoholism as the condition for 

coverage.

Table 6 lists the 32 States that require 

some coverage of mental health conditions, 

also described as mental health parity or 

mandated minimum mental health benefits. 

Table 7 depicts the same findings for substance use disorders in 29 States.

Continued
42 Special Report

Table 6. States Requiring Parity or Mandating Minimum Benefits—

Mental Health, continued

State Condition Requirement

Michigan Mental health Minimum mandated benefit

Minnesota Mental illness Parity for HMOs

Mississippi Mental illness Minimum mandated benefits for employers of more 

than 100

Montana Severe mental illness Parity

Montana Mental illness Mandated benefits

Nevada Severe mental illness Mandated benefits

New Hampshire Mental illness Parity for biologically based mental illness; minimum 

mandated benefits for other mental illnesses

New Jersey Biologically based mental illness 

(group, individual, and State employee 

plan)

Parity

New Mexico Mental health benefits as described in 

the group health plan

Parity

North Carolina Mental illness Parity

Oklahoma Severe mental illness Parity

Oregon Mental illness Mandated benefit

Pennsylvania Serious mental illness Mandated benefit

Rhode Island Serious mental illness Parity

Rhode Island Mental illness Minimum mandated benefit

South Carolina Mental illness Parity

South Dakota Biologically based mental illness Parity

Tennessee Mental illness Mandated benefits

Texas Serious mental illness Mandated benefit with a mandated offering for small 

groups of 50 or fewer (law effective 1/1/04 allows 

insurers and HMOs to offer policies without this 

mandate)

Texas Serious mental illness Minimum mandated benefit

Vermont Mental illness Parity

Virginia Mental illness Mandated benefits

West Virginia Serious mental illness Parity
State Mandates for Treatment for Mental Illness and Substance Use Disorders 43

Table 7. States Requiring Parity or Mandating Minimum Benefits—

Substance Use Disorders

State Condition Requirement

Arkansas Substance use disorders Mandated offering for substance use 

disorders

Colorado Biologically based mental illnesses (SA) Parity

Connecticut Substance use disorders Parity

Delaware Substance use disorders Parity

Hawaii Substance use disorders Mandated benefits

Illinois Alcoholism Mandated benefit

Kansas Substance use disorders Mandated benefits

Kansas Substance use disorders Mandated benefits 

Maine Substance use disorders Parity

Maryland Substance use disorders; residential crisis 

services defined as intensive mental health 

and support services

Minimum mandated benefit (statutory 

language; insurer can provide no less)

Massachusetts Substance use disorders Parity for biologically based illnesses, 

mandated benefits for other DSM 

diagnoses

Michigan Substance use disorders Minimum mandated benefit

Minnesota Substance use disorders Parity for HMOs

Mississippi Alcoholism Mandated benefit 

Montana Substance use disorders Mandated benefits

Nevada Substance use disorders Mandated benefits

New Hampshire Substance use disorders and alcoholism Minimum mandated benefits

New Jersey Alcoholism (group and individual) Mandated benefit for care prescribed by 

a doctor

North Carolina Substance use disorders Parity

North Dakota Substance use disorders Mandated benefit

Ohio Alcoholism Mandated benefit

Oregon Substance use disorders Mandated benefit

Pennsylvania Substance use disorders Mandated benefit

Rhode Island Substance use disorders Minimum mandated benefit

South Carolina Substance use disorders Parity

Texas Substance use disorders Mandated benefit with a mandated 

offering for self-insured plans of 250 or 

fewer employees

Vermont Substance use disorders Parity

Virginia Substance use disorders Mandated benefits

Washington Substance use disorders Mandated benefits

West Virginia Substance use disorders Parity

State Laws

A. State Standards for Mental Health 

Workers

Through law and regulation, States govern 

health professions, specifying what procedures and functions are legally within the 

purview of members of an individual profession. Generally regarded as “scope of 

practice,” these statutes and rules define 

the required educational and training 

preparation, and the procedures that can be 

administered and by whom, including what, 

if any, tasks can be delegated with supervision. In the eyes of the States, licensing is 

done only to protect the public from harm—

not to ensure reimbursement or recognition.

Most States require professional and 

nonprofessional mental health employees to 

meet certain standards to be legally allowed 

to provide clinical services to clients. The 

most commonly recognized mental health 

professionals are psychiatrists, psychologists, 

psychiatric nurses, social workers, professional counselors, and marriage and family 

therapists (MFTs). States can establish either 

a licensing process, in which licensure is 

established through law and regulation to 

protect the public (e.g., through disciplinary 

measures) and define the scope of practice; 

or a certifying process, in which certification, awarded by a nongovernmental entity, 

is recognized by the State. 

All 50 States have legal regulations governing psychiatrists, psychologists, psychiatric nurses, and social workers. For instance, 

social workers in Utah and Wyoming can 

choose to be recognized either by licensure 

or certification. Professional counselors can 

receive licenses in all jurisdictions, but 

Arkansas, California, Nevada, and Washington statutes include variations in the titles 

that are recognized. 

MFTs are licensed in every State except 

North Dakota, West Virginia, Delaware, and 

Montana. In four States (Indiana,3

 Iowa,4

Massachusetts,5

 and Washington6), MFT 

licensure is also extended to “mental health 

counselors.” This category is identified as 

“mental health worker” in Wyoming, which 

codifies certification instead of licensure. 

MFTs have graduate training (a master’s or 

doctoral degree) in marriage and family 

therapy and at least 2 years of clinical experience. According to the Web site of the 

American Association of Marriage and Family Therapists, MFTs treat the full range of 

mental and emotional disorders and health 

problems, including adolescent drug abuse, 

depression, alcoholism, obesity, and dementia in the elderly, as well as marital distress 

and conflict. Marriage and family therapists 

are licensed or certified in 46 States, but 

whether the practice scope includes substance use disorders counseling is determined by each State. 

Nurses are licensed in all 50 States and 

in the District of Columbia. Many States 

require certification for an advanced practice 

license. Certification for psychiatric nurses, 

at all levels, is provided by the American 

IV.

State Mandates for Treatment for Mental Illness and Substance Use Disorders 45
46 Special Report

Nurses Credentialing Center (http://www.

nursingworld.org/ancc/). 

Advanced practice registered nurses 

(APRNs) hold a master’s degree in psychiatric-mental health nursing (PMHN). 

PMHN is considered a specialty in nursing. 

In many States, APRNs have the authority 

to prescribe medications. 

B. State Standards for Addiction 

Treatment Workers

A range of professionals may provide services 

to individuals with substance use disorders, 

including licensed physicians, nurses, psychologists, counselors, and clinical social workers. 

The addiction treatment worker classification 

most frequently recognized in State law or 

regulation include addiction counselors, alcohol and drug counselors, behavioral health 

counselors, certified therapeutic counselors, 

drug and alcohol abuse counselors, drug 

addiction counselors, drug addiction and 

addiction treatment counselors, drug treatment counselors, chemical dependency counselors, substance use disorders counselors, 

alcohol and drug counselors, addiction treatment professionals or counselors, and rehabilitation counselors. For the purpose of this 

report, all the above titles are considered 

acceptable derivatives of the addiction treatment professional known as the addiction 

treatment counselor. Fewer States elect to 

license workers in the substance use disorders 

field than in the mental health field, and certification is more common.

The determinations of professional and 

occupational eligibility to provide services are 

made on a State-by-State basis. Most States 

require, through statute or more commonly, 

regulation, alcohol and drug professionals to 

meet certain competency standards to provide 

clinical services. While most States have chosen certification, an increasing trend is to 

license counselors. In some States, certification 

is a voluntary process and persons are allowed 

to practice as substance abuse counselors 

without it. Often, substance abuse counselors 

work in agencies that are themselves licensed 

by the State, so this facility license may provide similar protections for the public. Moreover, certification can be a function of a State 

board or an outside nongovernmental entity, 

such as a professional association or certification body. The certification boards, whether 

State or nongovernmental, are authorized to 

examine and certify all drug and alcohol counselors and professionals for entry into the 

alcohol and drug counseling profession; provide professional competency standards that 

promote excellence in care, appropriate education, and clinical training of counselors; and 

assist counselors in providing quality treatment services.

For a comprehensive analysis of certification standards for counselors and prevention professionals, see a publication released in 

January 2005 by SAMHSA entitled 

A National Review of State Alcohol and Drug 

Treatment Programs and Certification Standards for Counselors and Prevention Professionals. Available at http://ncadistore.

samhsa.gov/catalog/productDetails.

aspx?ProductID=17024, it lists the relevant 

regulatory board in each State and the myriad 

certifications recognized as well as other 

requirements, including, for example, supervision, exam requirements, adherence to a code 

of ethics, and requirements for recertification. 

Additional information on specific standards 

and requirements for individual States can be 

accessed at http://www.nattc.org, the Web site 

of the Addiction Technology Transfer Center. 

Select the “Certification info” tab to search by 

State, territory, country organization, or 

keyword.
V. Analysis of 

Prescriptive Authority 

in the States

A. Psychiatrists and Psychologists

Psychiatrists, who are physicians licensed to 

practice medicine in all its branches, are recognized by every jurisdiction, and the psychiatric scope of practice includes full prescriptive authority. In contrast, psychologists have 

not traditionally prescribed drugs, but the 

profession has recently embarked upon a legislative campaign throughout the country in 

pursuit of prescriptive authority. As of 2005, 

Louisiana and New Mexico were the only 

States to enact such statutes.

B. Advanced Practice Nurses and 

Physician Assistants

Nurse practitioners (NPs) and Physician 

Assistants (PAs) were first granted prescriptive authority in 1969. Virtually all States 

allow both entities prescribing privileges. 

(Hooker and Cipher, 2005). By 2006, NPs 

could prescribe in all 50 states plus the District of Columbia and independently of physicians in at least 14 states. NPs may prescribe controlled substances in 14 jurisdictions, with some degree of physician 

involvement in 33 other states. In 4 states, 

their prescriptive privileges exclude controlled substances. (Phillips, 2006).

Advanced practice nurses, who hold master’s degrees, also have broad prescriptive 

authority throughout the United States, and 

the profession is recognized in State licensing 

laws by numerous titles, all describing or 

requiring generally the same level of 

competence. 

For example, as illustrated in Table 8, 

14 different advanced nursing practice titles 

are recognized by States for the same level 

of professional practitioner. Often umbrella 

titles such as advanced practice registered 

nurse (APRN) or advanced registered nurse 

practitioner (ARNP) are used in nurse practice acts to signify all categories of advanced 

practice providers who have prescriptive 

authority (e.g., nurse practitioner (NP), clinical nurse specialist (CNS)). Other variations 

include certified registered nurse practitioner 

(CRNP), certified clinical nurse specialist 

(CCNS), psychiatric-mental health clinical 

nurse specialist (PMHCNS), and registered 

nurse practitioner (RNP).

State Mandates for Treatment for Mental Illness and Substance Use Disorders 47

Only four professions are currently authorized to prescribe drugs for 

patients with behavioral health problems: physicians (including psychiatrists), psychologists, advanced practice nurses, and physician assistants.
48 Special Report

In positions advanced by the American 

Psychiatric Nurses Association (APNA), the 

American Nurses Association (ANA), and the 

Society for Education and Research in Psychiatric-Mental Health Nursing, as well as others (Bjorklund, 2003; Delaney, Chisholm, 

Clement, & Merwin, 1999; Moller & Haber, 

2002; Naegle & Krainovich-Miller, 2001), 

the advanced practice role in the psychiatricmental health (PMH) nursing specialty 

increasingly reflects a set of core competencies with little differentiation between the role 

competencies of NPs and CNSs. Because of 

the decentralized nature of the State Boards 

of Nursing and the authority vested in each 

board to develop and enact nurse practice 

statutes, rules, and regulations related to their 

State, wide variations still exist from State to 

State with regard to titling, prescriptive 

authority, and requirements for obtaining 

and renewing prescriptive authority.

Kaas and colleagues (2002) noted that a 

major problem posed by having so many different titles to signify advanced practice psychiatric-mental health nursing status is the 

confusion this generates in consumers, policy 

makers, legislators, other health providers, 

and third-party payers, who are unable to 

readily identify the advanced practice 

“brand” of their provider.

The type of prescriptive authority States 

grant to advanced practice nurses can be 

qualified as supervisory, collaborative, or 

independent prescriptive authority. Currently, 

only collaborative authority, used by 33 

States, and independent prescriptive authority, by 16 States are employed. In Louisiana, 

for example, collaborative authority is granted to the APRN, which means a cooperative 

working relationship is established with a 

licensed physician to jointly contribute to 

providing patient care, which may include 

but is not limited to discussion of a patient’s 

diagnosis and cooperation in the management and delivery of health care. The Louisiana statute goes on to define “collaborative 

practice” as “the joint management of the 

health care of a patient by an advanced practice registered nurse performing advanced 

practice registered nursing and one or more 

consulting physicians or dentists.... Acts of 

medical diagnosis and prescription by an 

advanced practice registered nurse shall be 

in accordance with a collaborative practice 

agreement,” which is “a formal written statement addressing the parameters of the collaborative practice which are mutually agreed 

upon by the APRN and one or more licensed 

physicians or dentists which includes, but is 

not limited to, the physician availability.”

As an example of independent prescriptive 

authority Iowa allows “advanced registered 

nurse practitioners (ARNPs) registered in 

Iowa in a recognized nursing specialty to 

prescribe, deliver, distribute, or dispense prescription drugs, devices, and medical gases 

when the nurse is engaged in the practice of 

that nursing specialty.” Table 9 displays the 

Table 8. Advanced Practice Titles

Abbreviation Title

ANP Advanced nurse practitioner

APNP Advanced practice nurse practitioner

APPN Advanced practice professional nurse

APN Advanced practice nurse

APRN Advanced practice registered nurse

ARNP Advanced registered nurse practitioner

CNP Certified nurse practitioner

CNS Clinical nurse specialist

CCNS Certified clinical nurse specialist

CRNP Certified registered nurse practitioner

NP Nurse practitioner

RNP Registered nurse practitioner

PMHCNS Psychiatric-mental health clinical nurse 

specialist

PMHCNP Psychiatric-mental health clinical nurse 

practitioner
State Mandates for Treatment for Mental Illness and Substance Use Disorders 49

Table 9. Advanced Practice Nurses—Prescriptive Authority

State Title recognized

Prescriptive 

authority

National 

certification 

required

Type of authority: 

Independent (I) 

Collaborative (C)

Supervised (S) Notes

Alabama CRNP

CNS

Yes Yes C

Alaska ANP* Yes I *Certified CNSs from other States 

are eligible for certification as ANP

Arizona RNP

CNS

Yes

No

No*

Yes

I *If applying after 7/1/04, 

certification required

Arkansas APN includes

 - ANP

 - CNM

 - CNS

 - CRNA

Yes

Yes

Yes

Yes

Yes

C

C

C

C

California NP

CNS*

Yes**

No

No

No

C *Protected title requiring State 

certification

**Must have a “furnishing” 

number from board of nursing and 

6 months’ physician supervision in 

furnishing drugs

Colorado APN includes

 - NP

 - CNS

Yes Yes I

Connecticut APRN includes

 - NP

 - CNS

 - CNM

 - CRNA

Yes Yes C

Delaware APN Yes Yes I Need written plan with physician 

for consultation and referral

District of 

Columbia

NP

CNS

Yes

Yes

* I

I

*Not specified

Florida ARNP includes

 - NP

 - CNS*

Yes Yes C** *CNS is not recognized but may 

apply for licensure as ARNP.

**Protocols established between 

ARNP and physician with separate 

written contract

Georgia APRN includes

 - NP

 - CNS-PMH

No* Yes *May not prescribe, but APRN may 

be delegated by physician under 

protocols to “order”

Hawaii APRN includes

 - NP

 - CNS

 - CNM

 - CRNA

Yes Yes * * - 1000 hours of clinical 

experience as APRN in specialty

 - Must have written collegial 

relationship with physician

 - Physician’s name must appear 

on prescriptions

Continued
50 Special Report

Table 9. Advanced Practice Nurses—Prescriptive Authority, continued

State Title recognized

Prescriptive 

authority

National 

certification 

required

Type of authority: 

Independent (I) 

Collaborative (C)

Supervised (S) Notes

Idaho APPN includes

 - CNS

 - NP

 - CNM

 - RNA

Yes

Yes

Yes

Yes

Yes

C

Illinois APN includes

 - CNP

 - CCNS

 - CNM

 - CRNA

Yes

Yes

Yes

Yes

Yes

C

Indiana NP

CNS

CNM

Yes

Yes

Yes

C**

C**

C**

**No collaborative agreement 

is necessary unless prescriptive 

authority is sought.

Iowa ARNP includes

 - NP

 - CNS

 - CNM

 - CRNA

Yes Yes I

Kansas ARNP includes

 - NP

 - CNS

 - NM

 - NA

Yes Yes C

Kentucky ARNP (CS*) Yes Yes C *A clinical specialist practicing as 

an APRN is required to register as 

ARNP.

Louisiana APRN includes

 - CNM

 - CRNA

 - CNS

 - NP

Yes Yes C

Maine APRN includes

 - CNP

 - CNM

 - CRNA

 - CNS

Yes*

Yes*

No

No

Yes** I *Restricted formulary

**APRNs approved before 

1/1/96 are considered to have 

met education and certification 

requirements.

Maryland APRN includes

 - NP

 - APRN/PMH

 - Nurse 

Psychotherapist*

Yes

No

Yes

Yes

C

I

*Protected title

Massachusetts NM

NP

PMH-CNS

RNA

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

C

C

C

S

Continued
State Mandates for Treatment for Mental Illness and Substance Use Disorders 51

Table 9. Advanced Practice Nurses—Prescriptive Authority, continued

State Title recognized

Prescriptive 

authority

National 

certification 

required

Type of authority: 

Independent (I) 

Collaborative (C)

Supervised (S) Notes

Michigan NP

NM

RNA

Yes Yes

Yes

Yes

C

Minnesota CNP

CNM

CNS-PMH

CNS

CRNA

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

C

C

C

C

C

Mississippi CNS

NP includes

 - NP

 - CNM

 - RNA

No

Yes

C

Missouri APN includes

 - NP

 - CNM

 - CRNA

Yes Yes* C *Identifies specific certifying 

boards

Montana APRN Yes Yes I* *Must have a “quality assurance” 

plan that requires quarterly review 

by physician and peers

Nebraska APRN includes

 - NP

 - CNS

Yes Yes C

Nevada APN* includes

 - NM

 - Nurse 

Psycho-therapist

 - NP

 - CNS

Yes* No** C *Prescriptive Privileges require 

1000 hours’ practice, pharmacology 

education, and collaborating 

physician attestation of 

competency.

**Certification required in absence 

of more common requirements

New 

Hampshire

ARNP includes

 - CNM

 - CRNA

 - NP

 - PMH-CNS

Yes* Yes I *Restricted formulary

New Jersey APN includes

 - NP

 - CNS

Yes Yes C

New Mexico CNP

CNS

Yes

Yes

Yes*

Yes

*NPs licensed before 12/85 are 

not required to have national 

certification.

New York NP

CNS*

Yes

No

No C *Not a recognized title

North Carolina NP Yes Yes C

Continued
52 Special Report

Table 9. Advanced Practice Nurses—Prescriptive Authority, continued

State Title recognized

Prescriptive 

authority

National 

certification 

required

Type of authority: 

Independent (I) 

Collaborative (C)

Supervised (S) Notes

North Dakota NP

CNS

Yes

Yes

Yes

Yes

C

C

Ohio NP

CNS

Yes

Yes

Yes C

C

Oklahoma ARNP includes

 - NP

 - CNS

Yes Yes C

Oregon NP

CNS

Yes

No

I

Pennsylvania CRNP includes

 - NP

 - CNS

Yes

No

Yes

C

Rhode Island CRNP

CNS P-MH

Yes

Yes

Yes

Yes

C

C

South Carolina APRN includes

 - NP

 - CNS

Yes Yes C

South Dakota NP

CNS

Yes

No

C

Tennessee CNP Yes Yes C

Texas NP

CNS

Yes

Yes

Yes C

C

Utah APRN Yes Yes I* *When prescribing schedule II 

and III drugs, must have written 

collegial relationship and a 

consultation and referral plan

Vermont APRN Yes Yes I

Virginia LNP

CNS

Yes

No

Yes

Yes

C

I

Washington ARNP Yes Yes I

West Virginia ANP Yes Yes C

Wisconsin APNP includes

 - NP

 - CNS

Yes Yes I

Wyoming APN includes

 - NP

 - CNS

Yes Yes I* *Must have plan for physician 

referral and plan of coverage

Source: Haber et al. (2003).
State Mandates for Treatment for Mental Illness and Substance Use Disorders 53

States that grant prescriptive authority and 

the type of authority granted, and those that 

have elected to require forms of national 

certification (in addition to licensure) as a 

qualification for prescriptive authority.

Physician assistants are health care professionals licensed, or in the case of those 

employed by the Federal government they 

are credentialed, to practice medicine with 

physician supervision. They are defined by 

State law, and certain educational requirements apply. PAs’ education in general 

requires a 26 -month training beyond achieving certain prerequisites to enter a program; 

it varies by State licensing requirements. The 

prerequisites are equivalent to about 3 years 

of undergraduate work, but most persons 

entering PA training have a bachelors degree 

and some experience in health care. To 

become licensed or certified, a clinical clerkship as well as passing a national exam is 

required; to practice, continuing hours 

training and recertification every 6 years 

is required.

PAs may conduct physical exams, diagnose and treat illnesses, order and interpret 

tests, counsel on preventive health care, 

assist in surgery, and write prescriptions. 

Within the physician-PA relationship, physician assistants exercise autonomy in medical 

decision making and provide a broad range 

of diagnostic and therapeutic services. PA 

prescriptive authority is always dependent on 

delegation by a supervising physician who 

need not necessarily be present. Table 10 

illustrates that PAs may prescribe in all 50 

States, the District of Columbia, and Guam. 

In ten States, they are restricted to a formulary; in five States they may not prescribe 

any controlled substances.

Table 10. Where Physician Assistants Are Authorized To Prescribe 

Jurisdiction Rx 

Status Restrictions Controlled Substances

Alabama Rx Formulary

Alaska Rx Sch. III-V

Arizona Rx

Sch. II-III limited to 14-day supply with board prescribing 

certification (72-hrs. without);

Sch.IV-V not more than 5 times in 6-month period per 

patient 

Arkansas Rx Sch. III-V

California Rx

PAs may write "drug orders" 

which, for the purposes 

of DEA registration, meet 

the federal definition of a 

prescription.

Sch. II-V*

Colorado Rx Sch. II-V

Connecticut Rx Sch. II-V

Delaware Rx Sch. II-V

District of 

Columbia Rx

Continued
54 Special Report

Continued

Jurisdiction Rx 

Status Restrictions Controlled Substances

Florida Rx Formulary of prohibited drugs

Georgia Rx Formulary Sch. III-V

Guam Rx Sch. III-V

Hawaii Rx Sch. III-V

Idaho Rx Sch. II-V

Illinois Rx Sch. III-V

Indiana Rx** Sch. III-V

Iowa Rx Sch. III-V; Sch. II (except depressants)

Kansas Rx Sch. II-V

Kentucky Rx

Louisiana Rx Sch. III-V 

Maine Rx Sch. III-V (Board may approve Sch.II for individual PAs)

Maryland Rx Sch. II-V

Massachusetts Rx Sch. II-V

Michigan Rx Sch. III-V; Sch. II (7-day supply) as discharge meds

Minnesota Rx Formulary Sch. II-V

Mississippi Rx Sch. II-V

Missouri Rx

Montana Rx Sch. II-V (Sch. II limited to 34-day supply)

Nebraska Rx Sch. II-V 

Nevada Rx Sch. II-V

New Hampshire Rx Sch. II-V

New Jersey Rx Sch. II-V ( certain conditions apply)

New Mexico Rx Formulary Sch. II-V

New York Rx Sch. III-V

North Carolina Rx Sch. II-V (Sch. II-III limited to 30-day supply)

North Dakota Rx Sch. III-V

Ohio Rx*** Sch. III-V

Oklahoma Rx Formulary Sch. III-V (limited to 30-day supply)

Oregon Rx Sch. II-V

Pennsylvania Rx Formulary

Sch. II-V. (Sch. II limited to 72 hours for initial therapy; 

30 days for ongoing therapy. Sch. III-V limited to 30-day 

supply unless for chronic condition.)

Table 10. Where Physician Assistants Are Authorized To Prescribe, 

continued
State Mandates for Treatment for Mental Illness and Substance Use Disorders 55

Jurisdiction Rx 

Status Restrictions Controlled Substances

Rhode Island Rx Sch. II-V

South Carolina Rx Formulary Sch. III-V

South Dakota Rx Sch. II-V (Sch. II limited to 30-day supply)

Tennessee Rx Sch. II-V

Texas Rx In specified practice sites Sch. III-V (limited to 30-day supply)

Utah Rx Sch. II-V

Vermont Rx Formulary Sch. II-V

Virginia Rx Sch. III-V (authorization for Sch. II prescribing begins 

7/1/07

Washington Rx Sch. II-V

West Virginia Rx Formulary Sch. III-V (Sch. III limited to 72-hr supply)

Wisconsin Rx Sch. II-V

Wyoming Rx Sch. II-V

5/10/07

DEA Registration

The Drug Enforcement Administration (DEA) has a registration category specifically for physician assistants and other so-called “midlevel 

practitioners” authorized by state law or regulation to prescribe controlled substances. For more information or to obtain a registration application, 

contact the DEA Registration Unit at 800/882-9539. Additional information on DEA registration can be found at www.aapa.org/gandp/issuebrief/DEA.htm.

* Controlled medications require a patient-specific order from the supervising physician.

** Statute authorizing delegated prescribing was passed in the 2007 legislative session, but regulations to implement prescriptive authority have not yet 

been adopted.

*** Statute authorizing delegated prescribing became effective 5/14/06, but regulations to implement prescriptive authority have not yet been adopted. 

This table is used with the permission of the American Academy of Physician Assistants and can be viewed at: http://www.aapa.org/gandp/rxchart.html.

C. State Actions on Psychotropic 

Drugs in Schools

An emerging issue related to prescribing 

authority is directed toward children and 

psychotropic medications. These drugs 

often are used in the treatment of children 

with attention deficit/hyperactivity disorder 

(ADHD), a condition that is being diagnosed with increasing frequency.

Some teachers and education officials 

have advocated for laws (or school policy) 

requiring afflicted students to take 

prescribed medication as a condition for 

participation in school activities. In reaction, a legislative backlash has begun in 

recent years as States have attempted to 

curtail these requirements. Three States 

(Colorado, Connecticut, and Texas) have 

passed laws prohibiting these policies and 

specifically forbidding school personnel 

from requiring or recommending prescriptive medication to students. Table 11 

describes the recent State legislative activity 

addressing this issue.

Table 10. Where Physician Assistants Are Authorized To Prescribe, 

continued
56 Special Report

Table 11. Psychotropic Drugs—Prohibitions on School Employees

State

Not 

permitted to 

require or 

recommend 

drugs

Not permitted 

to limit 

access to 

school or 

activities Other

California Legislation passed encouraging the Federal government to study the 

use of psychotropic drugs to treat children

####

Only a juvenile court judicial officer shall have authority to make 

orders regarding the administration of psychotropic medications for 

a child removed from the physical custody of the parent.

Colorado X

Connecticut X Refusal of a parent or guardian to administer or consent to the 

administration of any psychotropic drug to such child shall not, by 

itself, constitute grounds for the Department of Children and Families 

to take such child into custody.

Illinois Psychotropic medication shall not be prescribed without the 

informed consent of the resident or the resident’s guardian.

Massachusetts Health Department to promulgate regulations governing the 

administration of psychotropic medications to children in school 

settings

New Hampshire Refusal of a parent to administer or consent to the administration of 

any psychotropic drug shall not, by itself, constitute grounds for the 

police to take the child into custody.

Oregon Adopted procedures for use of psychotropic medications for 

children in foster care

South Dakota Delineates the procedure for petitioning the circuit court for the 

authority to administer psychotropic medication to an involuntarily 

committed patient

Texas X X Refusal of a parent or guardian to administer or consent to the 

administration of a psychotropic drug to the child does not by itself 

constitute neglect.

####

An employee of a school district may not use or threaten to use the 

refusal of a parent or guardian of a child to administer or consent 

to the administration of a psychotropic drug to the child as the sole 

basis for making a report of neglect of the child.
State Mandates for Treatment for Mental Illness and Substance Use Disorders 57

Conclusion

This report reviewed the current state mandates and trends regarding 

benefits, coverage, prescriptive authorities and parity. A brief summary 

follows.

VI.

1. State-mandated benefits for 

behavioral health care 

Most States have enacted some relevant 

legislation, but concerns about rising health 

care costs have led State legislatures to scale 

back previously required benefits. With the 

cost of health care coverage an increasingly 

large portion of State and private sector 

budgets, there are few reasons to expect that 

this trend to scale back will not continue at 

least for the near-term future.

In general, State legislators enacted legislation to mandate insurance coverage for 

mental illness and substance use disorders 

approximately 20 years before the U.S. Congress. While the States initially focused on 

mandated offering and mandated benefits, 

over time, State legislators began to require 

parity between mental and physical health 

treatment. The current status of mental illness and substance use disorders legislation 

in the United States is a veritable patchwork. Nearly all States have enacted legislation requiring health insurance companies to 

provide some coverage—mandated offering, 

mandated benefits, or parity coverage—for 

mental illness and substance use disorders. 

Nevertheless, substance use disorders coverage continues to lag behind benefits 

for mental health treatment. 

2. State laws regulating behavioral 

health care workers

States generally tend to license personnel in 

the mental health field and certify workers 

who provide substance use disorders 

treatment. 

3. Analysis of State-recognized 

prescriptive authority for 

psychotropic drugs

Regarding personnel, the primary trend 

seems to be a State movement toward 

granting greater prescriptive authority 

for health care professionals, particularly psychologists. There are considerable concerns 

about the cost of prescriptions that could be 

impacted by the State recognizing more professionals with prescriptive authority.
58 Special Report

American Academy of Physician Assistants 

(May 2007). “Where Physician Assistants 

are Authorized to Prescribe.” Retrieved 

with permission from the American 

Academy of Physician Assistants from 

http://www.aapa.org/gandp/rxchart.html. 

American Nurses Association (2000). Scope 

and standards of psychiatric-mental 

health nursing practice. Washington, DC: 

Author.

American Psychiatric Nurses Association 

(2003). Position paper on titling and 

credentialing. Washington, DC: Author.

Bjorklund, P. (2003). The certified psychiatric 

nurse practitioner: Advanced practice 

psychiatric nursing reclaimed. Archives of 

Psychiatric Nursing, 17, 77–87.

Delaney, K. R., Chisholm, M., Clement, 

J., & Merwin, E. I. (1999). Trends 

in psychiatric-mental health nursing. 

Archives of Psychiatric Nursing, 13,

67–73.

Haber, J., Hamera, E., Hillyer, D., Limandri, 

B., Pagel, S., Staten, R., et al. (December 

2003). Advanced practice psychiatric 

nurses: 2003 legislative update. Journal 

of the American Psychiatric Nurses 

Association. Retrieved from www.apna.

org.

Hooker, R., & Cipher, D. (2005). Physician 

Assistant and Nurse Practitioner 

Prescribing: 1997–2002. The Journal of 

Rural Health, Vol 21, No. 4, 355–360.

Kaas, M. J., Moller, M. D., Markley, J. M., 

Billings, C. V., Haber, J., Hamera, E., 

et al. (2002). Prescriptive authority for 

advanced practice psychiatric nurses: 

State of the states, 2001. Journal of the 

American Psychiatric Nurses Association, 

8, 99–105.

Moller, M. D., & Haber, J. (2002). Advanced 

practice psychiatric nursing: The need 

for a blended role. Journal of Issues in 

Nursing, August 2, 2002. Retrieved from 

http://www.nursingworld.org/ojin/tpcl/

tpcl_7.htm.

Naegle, M. A., & Krainovich-Miller, B. 

(2001). Shaping the advanced practice 

psychiatric mental health nursing role: 

A futuristic model. Issues in Mental 

Health Nursing, 22, 461–482.

National Association of Clinical Nurse 

Specialists (1998). Statement on clinical 

nurse specialist practice and education. 

Indianapolis, IN: Author.

Phillips, S. (Jan. 2006). A comprehensive 

look at the legislative issues affecting 

advanced nursing practice. The Nurse 

Practitioner, Vol 31, No. 1, 6–11.

Substance Abuse and Mental Health 

Services Administration (January 2005). 

A national review of state alcohol 

and drug treatment programs and 

certification standards for counselors 

and prevention professionals. Retrieved 

from http://store.health.org/catalog/

productDetails.aspx?ProductID=17024.

Society for Education and Research in 

Psychiatric-Mental Health Nursing 

(1996). Educational preparation for 

psychiatric-mental health nursing 

practice. Pensacola, FL: Author.

References
State Mandates for Treatment for Mental Illness and Substance Use Disorders 59

Notes

1. Many terms have been used to describe the 

addiction treatment profession. The current 

term accepted by most scientists and experts 

in the field is substance use disorders. For 

the purposes of this report, this term will be 

used throughout.

2. Indiana defines “mental health counseling” as “a specialty that (1) uses counseling 

and psychotherapeutic techniques based 

on principles, methods, and procedures of 

counseling that assist people in identifying 

and resolving personal, social, vocational, 

intrapersonal, and interpersonal concerns; 

(2) uses counseling to evaluate and treat 

emotional and mental problems and conditions in a variety of settings, including mental and physical health facilities, child and 

family service agencies, or private practice, 

and including the use of accepted evaluation classifications, including classifications 

from the American Psychiatric Association’s 

Diagnostic and Statistical Manual of 

Mental Disorders (DSM-IV) as amended 

and supplemented, but only to the extent of 

the counselor’s education, training, experience, and scope of practice as established by 

this article; (3) administers and interprets 

appraisal instruments that the mental health 

counselor is qualified to employ by virtue 

of the counselor’s education, training, and 

experience; (4) uses information and community resources for personal, social, or 

vocational development; (5) uses individual 

and group techniques for facilitating problem solving, decision making, and behavioral change; (6) uses functional assessment 

and vocational planning guidance for persons requesting assistance in adjustment to 

a disability or disabling condition; (7) uses 

referrals for individuals who request counseling services; and (8) uses and interprets 

counseling research.”

“An individual who applies for a license 

as a mental health counselor must have a 

master’s or doctoral degree in an area related to mental health counseling; completed 

specified educational and experience requirements; no record of having a conviction for 

a crime that has a direct bearing on the individual’s ability to practice competently; not 

been the subject of a disciplinary action by 

a licensing or certification agency of another 

State or jurisdiction on the grounds that the 

individual was not able to practice as a mental health counselor without endangering the 

public; passed an examination provided by 

the board.”

3. Iowa defines “mental health counseling” as 

the “provision of counseling services involving assessment, referral, consultation, and 

the application of counseling, human development principles, learning theory, group 

dynamics, and the etiology of maladjustment and dysfunctional behavior to individuals, families, and groups. An individual 

is eligible for licensure in Iowa as a mental 

health counselor when s/he possesses a 

master’s degree in counseling consisting of at 

least 45 credit hours, or its equivalent, from 

a nationally accredited institution or from a 

program approved by the board; has at least 

2 years of clinical experience, supervised by 

a licensee, in assessing mental health needs 

and problems and in providing appropriate 

mental health services as approved by the 

Board of Behavioral Science Examiners in 

consultation with the Mental Health and 

Developmental Disabilities Commission; 

and passes an examination administered by 

the Board.”

4. Massachusetts defines the qualifications 

for mental health counselors in the same 

statute with marriage and family therapists, 

rehabilitation counselors, mental health 
60 Special Report

counselors, and educational psychologists 

who may be licensed upon providing “satisfactory evidence to the board that s/he 

(1) is of good moral character; (2) has not 

engaged or is not engaging in any practice 

or conduct that would be grounds for refusing to issue a license under section 169; (3) 

demonstrates to the board the successful 

completion of a master’s degree in a relevant field from an educational institution 

licensed by the State in which it is located 

and meets national standards for granting 

of a master’s degree with a subspecialization 

in marriage and family therapy, rehabilitation counseling, counseling, or a relevant 

subspecialization approved by the board. 

To be eligible for licensure, an applicant 

must have 2 additional years of supervised 

clinical experience in the relevant field in 

either a clinic or hospital licensed by the 

department of mental health or accredited 

by the Joint Commission on Accreditation 

of Hospitals or in an equivalent center or 

institute or under the direction of a supervisor approved by the board. For purposes of 

this clause, ‘supervision’ shall be defined as 

no fewer than 200 hours of supervised clinical experience, at least 100 hours of which 

shall consist of individual supervision with 

a clinician who has expertise in marriage 

and family therapy, rehabilitation counseling, educational psychology, or counseling, 

and who holds a master’s degree in social 

work, marriage and family therapy, rehabilitation counseling, educational psychology, 

counseling, or an equivalent field, or holds a 

doctoral degree in psychology, or a medical 

degree with a subspecialization in psychiatry; and (4) successfully passes a written or 

oral examination administered by the board 

to determine the applicant’s qualifications 

for licensure for each profession licensed 

pursuant to this section.”

5. Washington State defines “counseling” 

as employing any therapeutic techniques, 

“including but not limited to social work, 

mental health counseling, marriage and 

family therapy, and hypnotherapy, for a fee 

that offer, assist, or attempt to assist an individual or individuals in the amelioration or 

adjustment of mental, emotional, or behavioral problems, and includes therapeutic 

techniques to achieve sensitivity and awareness of self and others and the development 

of human potential. For the purposes of this 

chapter, nothing may be construed to imply 

that the practice of hypnotherapy is necessarily limited to counseling.”

Washington uses an omnibus credentialing act to “issue a registration to any 

applicant who submits, on forms provided 

by the secretary, the applicant’s name, 

address, occupational title, name and location of business, and other information 

as determined by the secretary, including 

information necessary to determine whether 

there are grounds for denial of registration 

or issuance of a conditional registration 

under this chapter or chapter 18.130 RCW. 

Applicants for registration shall register as 

counselors or may register as hypnotherapists if employing hypnosis as a modality. 

Applicants shall, in addition, provide in 

their titles a description of their therapeutic 

orientation, discipline, theory, or technique. 

Each applicant shall pay a fee determined by 

the secretary as provided in RCW 43.70.50, 

which shall accompany the application.”



DHHS Publication No. (SMA) 07-4228

Printed 2006