HF 295

as introduced - 83rd Legislature (2003 - 2004) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to insurance; eliminating mental health and 
  1.3             substance abuse treatment carve-outs; proposing coding 
  1.4             for new law in Minnesota Statutes, chapter 62Q. 
  1.5   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.6      Section 1.  [PURPOSE.] 
  1.7      The legislature finds and declares that: 
  1.8      (a) Minnesota health plans frequently carve-out mental 
  1.9   health and substance abuse treatments from other health care 
  1.10  benefits provided by the plan.  These carve-outs typically have 
  1.11  a separate financing and delivery system aimed at reducing the 
  1.12  costs of mental health and substance abuse benefits provided by 
  1.13  the plan to enrollees. 
  1.14     (b) Carve-outs are often used by health plans as a tool to 
  1.15  deny necessary and appropriate care, intimidate and confuse 
  1.16  patients, reduce the likelihood that care will be sought, and 
  1.17  create additional barriers to physicians and patients in seeking 
  1.18  mental health or substance abuse treatment. 
  1.19     (c) Separating mental health and substance abuse treatment 
  1.20  from other medical services provided under the health plan's 
  1.21  contract has a detrimental effect on the overall health of 
  1.22  patients who may suffer from interrelated medical conditions. 
  1.23     Sec. 2.  [62Q.529] [MENTAL HEALTH AND SUBSTANCE ABUSE 
  1.24  TREATMENTS.] 
  1.25     Subdivision 1.  [DEFINITIONS.] (a) "Carve-out" means a 
  2.1   financial arrangement for the provision and/or management of a 
  2.2   clinically defined subset of a health plan's benefits, which is 
  2.3   separate from the financial arrangement for the provision and 
  2.4   management of the other plan benefits. 
  2.5      (b) "Health plan" means a health plan as defined in section 
  2.6   62Q.01, subdivision 3, but includes the coverages listed in 
  2.7   section 62A.011, subdivision 3, clauses (7) and (10). 
  2.8      Subd. 2.  [REQUIREMENTS.] (a) Health plans providing or 
  2.9   contracting for the provision of health care services shall not 
  2.10  carve-out mental health or substance abuse treatments from other 
  2.11  covered benefits. 
  2.12     (b) Every health plan must: 
  2.13     (1) apply the same benefit structure, financial structure, 
  2.14  and administrative system to all covered benefits; and 
  2.15     (2) include all physicians and mental health professionals 
  2.16  who participate in the plan's network in complete listings of 
  2.17  participating plan providers and provide these lists to plan 
  2.18  enrollees at least annually and upon their request.  
  2.19     (c) Every health plan must comply with the requirements for 
  2.20  outpatient and inpatient mental health and substance abuse 
  2.21  benefits as defined in section 62Q.47 and the minimum 
  2.22  definitions of medical necessity as defined in section 62Q.53. 
  2.23     (d) State laws governing internal and external appeal and 
  2.24  review procedures, direct access to specialists, and continuity 
  2.25  of care apply to all benefits covered by the health plan 
  2.26  including mental health and substance abuse treatment. 
  2.27     Sec. 3.  [SEVERABILITY.] 
  2.28     If any provision of this act is held by a court to be 
  2.29  unconstitutional and void, the remaining provisions remain valid.
  2.30     Sec. 4.  [EFFECTIVE DATE; APPLICATION.] 
  2.31     Sections 1 to 3 are effective the day following final 
  2.32  enactment and apply to all health plans issued or renewed to 
  2.33  provide coverage to a Minnesota resident on or after that date.