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Minnesota Legislature

Office of the Revisor of Statutes

HF 254

as introduced - 91st Legislature (2019 - 2020) Posted on 02/14/2019 05:08pm

KEY: stricken = removed, old language.
underscored = added, new language.

Bill Text Versions

Engrossments
Introduction Posted on 01/22/2019

Current Version - as introduced

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A bill for an act
relating to insurance; requiring parity between mental health benefits and other
medical benefits; defining mental health and substance use disorder; requiring
health plan transparency; requiring accountability from the commissioners of
health and commerce; amending Minnesota Statutes 2018, sections 62Q.01, by
adding subdivisions; 62Q.47.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2018, section 62Q.01, is amended by adding a subdivision
to read:


new text begin Subd. 1c. new text end

new text begin Classification of benefits. new text end

new text begin "Classification of benefits" means inpatient
in-network benefits, inpatient out-of-network benefits, outpatient in-network benefits,
outpatient out-of-network benefits, prescription drug benefits, and emergency care benefits.
These classifications of benefits are the only classifications that may be used by a health
plan company.
new text end

Sec. 2.

Minnesota Statutes 2018, section 62Q.01, is amended by adding a subdivision to
read:


new text begin Subd. 6a. new text end

new text begin Mental health conditions and substance use disorders. new text end

new text begin "Mental health
conditions and substance use disorders" means a condition or disorder that involves a mental
health condition or substance use disorder that (1) falls under any of the diagnostic categories
listed in the mental disorders section of the current edition of the International Classification
of Disease, or (2) is listed in the most recent version of the Diagnostic and Statistical Manual
of Mental Disorders. Substance use disorder does not include caffeine or nicotine use and
paraphilic disorders, specific learning disorders, and sexual dysfunctions.
new text end

Sec. 3.

Minnesota Statutes 2018, section 62Q.01, is amended by adding a subdivision to
read:


new text begin Subd. 6b. new text end

new text begin Nonquantitative treatment limitations or NQTLs. new text end

new text begin "Nonquantitative treatment
limitations" or "NQTLs" means processes, strategies, or evidentiary standards, or other
factors that are not expressed numerically, but otherwise limit the scope or duration of
benefits for treatment. NQTLs include but are not limited to:
new text end

new text begin (1) medical management standards limiting or excluding benefits based on (i) medical
necessity or medical appropriateness, or (ii) whether the treatment is experimental or
investigative;
new text end

new text begin (2) formulary design for prescription drugs;
new text end

new text begin (3) health plans with multiple network tiers;
new text end

new text begin (4) criteria and parameters for provider inclusion in provider networks, including
credentialing standards and reimbursement rates;
new text end

new text begin (5) health plan methods for determining usual, customary, and reasonable charges;
new text end

new text begin (6) fail-first or step therapy protocols;
new text end

new text begin (7) exclusions based on failure to complete a course of treatment;
new text end

new text begin (8) restrictions based on geographic location, facility type, provider specialty, and other
criteria that limit the scope or duration of benefits for services provided under the health
plan;
new text end

new text begin (9) in- and out-of-network geographic limitations;
new text end

new text begin (10) standards for providing access to out-of-network providers;
new text end

new text begin (11) limitations on inpatient services for situations where the enrollee is a threat to self
or others;
new text end

new text begin (12) exclusions for court-ordered and involuntary holds;
new text end

new text begin (13) experimental treatment limitations;
new text end

new text begin (14) service coding;
new text end

new text begin (15) exclusions for services provided by clinical social workers; and
new text end

new text begin (16) provider reimbursement rates, including rates of reimbursement for mental health
and substance use disorder services in primary care.
new text end

Sec. 4.

Minnesota Statutes 2018, section 62Q.47, is amended to read:


62Q.47 ALCOHOLISM, MENTAL HEALTH, AND CHEMICAL DEPENDENCY
SERVICES.

(a) All health plans, as defined in section 62Q.01, that provide coverage for alcoholism,
mental health, or chemical dependency services, must comply with the requirements of this
section.

(b) Cost-sharing requirements and benefit or service limitations for outpatient mental
health and outpatient chemical dependency and alcoholism services, except for persons
placed in chemical dependency services under Minnesota Rules, parts 9530.6600 to
9530.6655, must not place a greater financial burden on the insured or enrollee, or be more
restrictive than those requirements and limitations for outpatient medical services.

(c) Cost-sharing requirements and benefit or service limitations for inpatient hospital
mental health and inpatient hospital and residential chemical dependency and alcoholism
services, except for persons placed in chemical dependency services under Minnesota Rules,
parts 9530.6600 to 9530.6655, must not place a greater financial burden on the insured or
enrollee, or be more restrictive than those requirements and limitations for inpatient hospital
medical services.

new text begin (d) A health plan must not impose an NQTL with respect to mental health and substance
use disorders in any classification of benefits unless, under the terms of the plan as written
and in operation, any processes, strategies, evidentiary standards, or other factors used in
applying the NQTL to mental health and substance use disorders in the classification are
comparable to, and are applied no more stringently than, the processes, strategies, evidentiary
standards, or other factors used in applying the NQTL with respect to medical/surgical
benefits in the same classification.
new text end

deleted text begin (d)deleted text endnew text begin (e)new text end All health plans must meet the requirements of the federal Mental Health Parity
Act of 1996, Public Law 104-204; Paul Wellstone and Pete Domenici Mental Health Parity
and Addiction Equity Act of 2008; the Affordable Care Act; and any amendments to, and
federal guidance or regulations issued under, those acts.

new text begin (f) A health plan that provides coverage for mental health and substance use disorders,
or chemical dependency services, must submit an updated annual report to the commissioner
on or before March 1 that contains the following information:
new text end

new text begin (1) a description of the health plan's criteria for mental health and substance use disorders
coverage, including a description of how the coverage is compliant with the requirements
of section 62Q.53 for medical and surgical benefits;
new text end

new text begin (2) identification of all NQTLs that are applied to mental health or substance use disorders
benefits and medical and surgical benefits;
new text end

new text begin (3) an analysis demonstrating that for the medical necessity criteria described in clause
(1) and for each NQTL identified in clause (2), as written and in operation, the processes,
strategies, evidentiary standards, or other factors used to apply the medical necessity criteria
and each NQTL to mental health and substance use disorders, benefits are comparable to,
and are applied no more stringently than the processes, strategies, evidentiary standards, or
other factors used to apply the medical necessity criteria and each NQTL, as written and in
operation, to medical and surgical benefits; at a minimum, the results of the analysis must:
new text end

new text begin (i) identify the specific factors the health plan company used in performing its NQTL
analysis;
new text end

new text begin (ii) identify and define the specific evidentiary standards relied on to evaluate the factors;
new text end

new text begin (iii) describe how the evidentiary standards are applied to each classification for benefits
for mental health and substance use disorders benefits, medical benefits, and surgical benefits;
new text end

new text begin (iv) disclose the results of the analyses of the specific evidentiary standards in each
service category; and
new text end

new text begin (v) disclose the specific findings of the health plan company in each service category
and the conclusions reached with respect to whether the processes, strategies, evidentiary
standards, or other factors used in applying the NQTL to mental health and substance use
disorders benefits are comparable to, and applied no more stringently than, the processes,
strategies, evidentiary standards, or other factors used in applying the NQTL with respect
to medical and surgical benefits in the same classification;
new text end

new text begin (4) the rates of and reasons for denial of claims for each classification of benefits for
mental health and substance use disorders services during the previous calendar year
compared to the rates of and reasons for denial of claims in those same classifications of
benefits for medical and surgical services during the previous calendar year;
new text end

new text begin (5) a certification signed by the health plan company's chief executive officer and chief
medical officer that states that the health plan company has completed a comprehensive
review of the administrative practices of the health plan company for the prior calendar year
for compliance with the necessary provisions of United States Code, title 42, section 18031(j),
as amended, and federal guidance or regulations issued under this section, sections 62Q.47
and 62Q.53, Code of Federal Regulations, title 45, parts 146 and 147, and Code of Federal
Regulations, title 45, section 156.115(a)(3); and
new text end

new text begin (6) any other information necessary to clarify data provided under this section requested
by the commissioner of commerce or health, including information that may be proprietary
or have commercial value.
new text end

new text begin (g) A health plan company must provide to the commissioners of commerce and health
an update to the annual report on March 1, 2021, and each subsequent year.
new text end

new text begin (h) The commissioner must implement and enforce applicable provisions of United
States Code, title 42, section 18031(j), as amended, and federal guidance or regulations
issued under this section, sections 62Q.47 and 62Q.53, Code of Federal Regulations, title
45, parts 146 and 147, and Code of Federal Regulations, title 45, section 156.115(a)(3),
which includes:
new text end

new text begin (1) ensuring compliance by individual and group health plans;
new text end

new text begin (2) detecting violations of the law by individual and group health plans;
new text end

new text begin (3) accepting, evaluating, and responding to complaints regarding such violations; and
new text end

new text begin (4) evaluating parity compliance for individual and group health plans, including but
not limited to reviews of network adequacy, reimbursement rates, denials, and prior
authorizations.
new text end

new text begin (i) The commissioner may request a formal opinion from the attorney general in the
event of uncertainty or disagreement with respect to the application, interpretation,
implementation, or enforcement of United States Code, title 42, section 18031(j), as amended,
and federal guidance or regulations issued under this section, including Code of Federal
Regulations, title 45, parts 146 and 147, and Code of Federal Regulations, title 45, section
156.115(a)(3).
new text end

new text begin (j) Beginning May 1, 2021, and each year thereafter, the commissioner of commerce,
in consultation with the commissioner of health, must issue an updated report to the
legislature. The report must:
new text end

new text begin (1) describe how the commissioners review health plan compliance with United States
Code, title 42, section 18031(j), and any federal regulations or guidance relating to
compliance and oversight;
new text end

new text begin (2) describe how the commissioners review compliance with sections 62Q.47 and 62Q.53;
new text end

new text begin (3) identify enforcement actions taken during the preceding 12-month period regarding
compliance with parity in mental health and substance use disorders benefits under state
and federal law and summarize the results of such market conduct examinations. This
summary must include:
new text end

new text begin (i) the number of formal enforcement actions taken;
new text end

new text begin (ii) the benefit classifications examined in each enforcement action;
new text end

new text begin (iii) the subject matter of each enforcement action, including quantitative and
nonquantitative treatment limitations; and
new text end

new text begin (iv) a description of how individually identifiable information will be excluded from
the reports consistent with state and federal privacy protections;
new text end

new text begin (4) detail any corrective actions the commissioners have taken to ensure health plan
compliance with sections 62Q.47 and 62Q.53 and United States Code, title 42, section
18031(j);
new text end

new text begin (5) detail the approach taken by the commissioners relating to informing the public about
alcoholism, mental health, or chemical dependency parity protections under state and federal
law; and
new text end

new text begin (6) be written in nontechnical, readily understandable language and must be made
available to the public by, among other means as the commissioners find appropriate, posting
the report on department websites.
new text end