SF 2485

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 07/05/2023 03:44pm

A bill for an act
relating to health; requiring commercial health plan coverage of certain treatment
at psychiatric residential treatment facilities; adding psychiatric treatment facility
to essential community provider designation; amending Minnesota Statutes 2022,
sections 62A.152, subdivision 3; 62K.10, subdivision 4; 62Q.19, subdivision 1;
62Q.47.

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

Section 1.

Minnesota Statutes 2022, section 62A.152, subdivision 3, is amended to read:

Subd. 3.

Provider discrimination prohibited.

All group policies and group subscriber
contracts that provide benefits for mental or nervous disorder treatments in a hospital must
provide direct reimbursement for those services new text begin at a hospital or psychiatric residential
treatment facility new text end if performed by a mental health professional qualified according to section
245I.04, subdivision 2, to the extent that the services and treatment are within the scope of
mental health professional licensure.

This subdivision is intended to provide payment of benefits for mental or nervous disorder
treatments performed by a licensed mental health professional in a hospital new text begin or psychiatric
residential treatment facility new text end and is not intended to change or add benefits for those services
provided in policies or contracts to which this subdivision applies.

Sec. 2.

Minnesota Statutes 2022, section 62K.10, subdivision 4, is amended to read:

Subd. 4.

Network adequacy.

Each designated provider network must include a sufficient
number and type of providers, including providers that specialize in mental health and
substance use disorder services, to ensure that covered services are available to all enrollees
without unreasonable delay. In determining network adequacy, the commissioner of health
shall consider availability of services, including the following:

(1) primary care physician services are available and accessible 24 hours per day, seven
days per week, within the network area;

(2) a sufficient number of primary care physicians have hospital admitting privileges at
one or more participating hospitals within the network area so that necessary admissions
are made on a timely basis consistent with generally accepted practice parameters;

(3) specialty physician service is available through the network or contract arrangement;

(4) mental health and substance use disorder treatment providers new text begin , including but not
limited to psychiatric residential treatment facilities, new text end are available and accessible through
the network or contract arrangement;

(5) to the extent that primary care services are provided through primary care providers
other than physicians, and to the extent permitted under applicable scope of practice in state
law for a given provider, these services shall be available and accessible; and

(6) the network has available, either directly or through arrangements, appropriate and
sufficient personnel, physical resources, and equipment to meet the projected needs of
enrollees for covered health care services.

Sec. 3.

Minnesota Statutes 2022, section 62Q.19, subdivision 1, is amended to read:

Subdivision 1.

Designation.

(a) The commissioner shall designate essential community
providers. The criteria for essential community provider designation shall be the following:

(1) a demonstrated ability to integrate applicable supportive and stabilizing services with
medical care for uninsured persons and high-risk and special needs populations, underserved,
and other special needs populations; and

(2) a commitment to serve low-income and underserved populations by meeting the
following requirements:

(i) has nonprofit status in accordance with chapter 317A;

(ii) has tax-exempt status in accordance with the Internal Revenue Service Code, section
501(c)(3);

(iii) charges for services on a sliding fee schedule based on current poverty income
guidelines; and

(iv) does not restrict access or services because of a client's financial limitation;

(3) status as a local government unit as defined in section 62D.02, subdivision 11, a
hospital district created or reorganized under sections 447.31 to 447.37, an Indian tribal
government, an Indian health service unit, or a community health board as defined in chapter
145A;

(4) a former state hospital that specializes in the treatment of cerebral palsy, spina bifida,
epilepsy, closed head injuries, specialized orthopedic problems, and other disabling
conditions;

(5) a sole community hospital. For these rural hospitals, the essential community provider
designation applies to all health services provided, including both inpatient and outpatient
services. For purposes of this section, "sole community hospital" means a rural hospital
that:

(i) is eligible to be classified as a sole community hospital according to Code of Federal
Regulations, title 42, section 412.92, or is located in a community with a population of less
than 5,000 and located more than 25 miles from a like hospital currently providing acute
short-term services;

(ii) has experienced net operating income losses in two of the previous three most recent
consecutive hospital fiscal years for which audited financial information is available; and

(iii) consists of 40 or fewer licensed beds;

(6) a birth center licensed under section 144.615; deleted text begin or
deleted text end

(7) a hospital and affiliated specialty clinics that predominantly serve patients who are
under 21 years of age and meet the following criteria:

(i) provide intensive specialty pediatric services that are routinely provided in fewer
than five hospitals in the state; and

(ii) serve children from at least one-half of the counties in the state new text begin ; or
new text end

new text begin (8) a psychiatric residential treatment facility as defined in section 256B.0625, subdivision
45a, paragraph (b), that is certified and licensed by the commissioner of health new text end .

(b) Prior to designation, the commissioner shall publish the names of all applicants in
the State Register. The public shall have 30 days from the date of publication to submit
written comments to the commissioner on the application. No designation shall be made
by the commissioner until the 30-day period has expired.

(c) The commissioner may designate an eligible provider as an essential community
provider for all the services offered by that provider or for specific services designated by
the commissioner.

(d) For the purpose of this subdivision, supportive and stabilizing services include at a
minimum, transportation, child care, cultural, and linguistic services where appropriate.

Sec. 4.

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 new text begin services, psychiatric residential treatment facility services, new text end 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.

(h) 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.