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SF 3930

as introduced - 91st Legislature (2019 - 2020) Posted on 03/05/2020 08:33am

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

Current Version - as introduced

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A bill for an act
relating to health coverage; limiting cost-sharing requirements for the first four
outpatient mental health service visits; amending Minnesota Statutes 2018, sections
62A.149, subdivision 1; 62A.152, subdivision 2; Minnesota Statutes 2019
Supplement, section 62Q.47.

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

Section 1.

Minnesota Statutes 2018, section 62A.149, subdivision 1, is amended to read:


Subdivision 1.

Application.

The provisions of this section apply to all group policies
of accident and health insurance and group subscriber contracts offered by nonprofit health
service plan corporations regulated under chapter 62C, and to a plan or policy that is
individually underwritten or provided for a specific individual and family members as a
nongroup policy, when the policies or subscriber contracts are issued or delivered in
Minnesota or provide benefits to Minnesota residents enrolled thereunder.

This section does not apply to policies designed primarily to provide coverage payable
on a per diem, fixed indemnity or nonexpense incurred basis or policies that provide accident
only coverage.

Every insurance policy or subscriber contract included within the provisions of this
subdivision, upon issuance or renewal, shall provide coverage that complies with the
requirements of section 62Q.47, paragraphs (b) and deleted text begin(c)deleted text endnew text begin (d)new text end, for the treatment of alcoholism,
chemical dependency or drug addiction to any Minnesota resident entitled to coverage.

Sec. 2.

Minnesota Statutes 2018, section 62A.152, subdivision 2, is amended to read:


Subd. 2.

Minimum benefits.

All group policies and all group subscriber contracts
providing benefits for mental or nervous disorder treatments in a hospital shall also provide
coverage that complies with the requirements of section 62Q.47, paragraphs (b) and deleted text begin(c)deleted text endnew text begin (d)new text end.

Sec. 3.

Minnesota Statutes 2019 Supplement, 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.

new text begin (c) Notwithstanding paragraph (b), a health plan shall not impose a cost-sharing
requirement greater than $25 per visit for the first four outpatient mental health service
visits that occur within a contract year. Any cost-sharing imposed for the first four visits
shall be applied toward the enrollee's annual deductible, if applicable, and to the out-of-pocket
maximum amount. For purposes of this paragraph, "cost-sharing" includes deductibles,
coinsurance, or co-payments, but does not include premiums, balance billing amounts for
non-network providers, or the cost of noncovered services.
new text end

deleted text begin (c)deleted text endnew text begin (d)new text end 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.

deleted text begin (d)deleted text endnew text begin (e)new text end 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.

deleted text begin (e)deleted text endnew text begin (f)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.

deleted text begin (f)deleted text endnew text begin (g)new text end 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.

deleted text begin (g)deleted text endnew text begin (h)new text end 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.

deleted text begin (h)deleted text endnew text begin (i)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.