SF 1490

as introduced - 93rd Legislature (2023 - 2024) Posted on 03/28/2023 03:26pm

A bill for an act
relating to insurance coverage; providing medical assistance and insurance coverage
of psychiatric collaborative care model; amending Minnesota Statutes 2022, sections
62Q.47; 256B.0671, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2022, 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.

(d) A health plan company 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 health
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 and surgical benefits in the same classification.

(e) 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.

(f) The commissioner may require information from health plan companies to confirm
that mental health parity is being implemented by the health plan company. Information
required may include comparisons between mental health and substance use disorder
treatment and other medical conditions, including a comparison of prior authorization
requirements, drug formulary design, claim denials, rehabilitation services, and other
information the commissioner deems appropriate.

(g) Regardless of the health care provider's professional license, if the service provided
is consistent with the provider's scope of practice and the health plan company's credentialing
and contracting provisions, mental health therapy visits and medication maintenance visits
shall be considered primary care visits for the purpose of applying any enrollee cost-sharing
requirements imposed under the enrollee's health plan.

new text begin (h) All health plan companies offering health plans that provide coverage for alcoholism,
mental health, or chemical dependency benefits shall provide reimbursement for such
benefits delivered through the psychiatric Collaborative Care Model, which must include
the following Current Procedural Terminology or Healthcare Common Procedure Coding
System billing codes:
new text end

new text begin (1) 99492;
new text end

new text begin (2) 99493;
new text end

new text begin (3) 99494;
new text end

new text begin (4) G2214; and
new text end

new text begin (5) G0512.
new text end

new text begin (i) The commissioner of commerce shall update the list of codes in paragraph (h) if there
are any alterations or additions to the billing codes for the psychiatric Collaborative Care
Model.
new text end

new text begin (j) "Psychiatric Collaborative Care Model" means the evidence-based, integrated
behavioral health service delivery method described at Federal Register, volume 81, page
80230, which includes a formal collaborative arrangement among a primary care team
consisting of a primary care provider, a care manager, and a psychiatric consultant, and
includes but is not limited to the following elements:
new text end

new text begin (1) care directed by the primary care team;
new text end

new text begin (2) structured care management;
new text end

new text begin (3) regular assessments of clinical status using validated tools; and
new text end

new text begin (4) modification of treatment as appropriate.
new text end

deleted text begin (h) deleted text end new text begin (k) new text end By June 1 of each year, beginning June 1, 2021, the commissioner of commerce,
in consultation with the commissioner of health, shall submit a report on compliance and
oversight to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and commerce. The report must:

(1) describe the commissioner's process for reviewing health plan company compliance
with United States Code, title 42, section 18031(j), any federal regulations or guidance
relating to compliance and oversight, and compliance with this section and section 62Q.53;

(2) identify any enforcement actions taken by either commissioner during the preceding
12-month period regarding compliance with parity for mental health and substance use
disorders benefits under state and federal law, summarizing the results of any market conduct
examinations. The summary must include: (i) the number of formal enforcement actions
taken; (ii) the benefit classifications examined in each enforcement action; and (iii) the
subject matter of each enforcement action, including quantitative and nonquantitative
treatment limitations;

(3) detail any corrective action taken by either commissioner to ensure health plan
company compliance with this section, section 62Q.53, and United States Code, title 42,
section 18031(j); and

(4) describe the information provided by either commissioner to the public about
alcoholism, mental health, or chemical dependency parity protections under state and federal
law.

The report must 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. Individually identifiable information must be
excluded from the report, consistent with state and federal privacy protections.

Sec. 2.

Minnesota Statutes 2022, section 256B.0671, is amended by adding a subdivision
to read:

new text begin Subd. 14. new text end

new text begin Psychiatric Collaborative Care Model. new text end

new text begin (a) Medical assistance covers the
psychiatric Collaborative Care Model for clients.
new text end

new text begin (b) "Psychiatric Collaborative Care Model" means the evidence-based, integrated
behavioral health service delivery method described at Federal Register, volume 81, page
80230, which includes a formal collaborative arrangement among a primary care team
consisting of a primary care provider, a care manager, and a psychiatric consultant, and
includes but is not limited to the following elements:
new text end

new text begin (1) care directed by the primary care team;
new text end

new text begin (2) structured care management;
new text end

new text begin (3) regular assessments of clinical status using validated tools; and
new text end

new text begin (4) modification of treatment as appropriate.
new text end

new text begin (c) Medical assistance covers the psychiatric Collaborative Care Model for clients when
the following Current Procedural Terminology or Healthcare Common Procedure Coding
System billing codes are used:
new text end

new text begin (1) 99492;
new text end

new text begin (2) 99493;
new text end

new text begin (3) 99494;
new text end

new text begin (4) G2214; and
new text end

new text begin (5) G0512.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end