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Minnesota Legislature

Office of the Revisor of Statutes

SF 1229

1st Engrossment - 91st Legislature (2019 - 2020) Posted on 05/18/2019 09:35am

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

Current Version - 1st Engrossment

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A bill for an act
relating to insurance; requiring parity between mental health benefits and other
medical benefits; requiring accountability from the commissioners of health and
commerce; amending Minnesota Statutes 2018, sections 62Q.01, by adding a
subdivision; 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. 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. 2.

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 and 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) The commissioner may require information from health plans to confirm that mental
health parity is being implemented. Information required may include comparisons between
mental health and substance use disorder treatment against other health care conditions for
other issues, prior authorizations, drug formularies, claim denials, rehabilitation services,
and other information the commissioner deems appropriate.
new text end

new text begin (g) Regardless of the care provider's professional license, if the care is consistent with
the provider's scope of practice and the health plan's credentialing and contracting provisions,
mental health therapy visits and medication maintenance visits are considered primary care
visits for the purposes of applying any patient cost-sharing requirements imposed by the
health plan. Beginning June 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 this section and section
62Q.53;
new text end

new text begin (3) identify enforcement actions taken during the preceding 12-month period regarding
compliance with parity for mental health and substance use disorders benefits under state
and federal law and summarize the results of such market conduct examinations. The
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 this section and section 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