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Legislative Year: 2019 Change
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Bill Detail: HB19-1269

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Title Mental Health Parity Insurance Medicaid
Status Governor Signed (05/16/2019)
Bill Subjects
  • Health Care & Health Insurance
  • Public Health
House Sponsors T. Sullivan (D)
L. Cutter (D)
Senate Sponsors J. Ginal (D)
R. Gardner (R)
House Committee Public Health Care and Human Services
Senate Committee Health and Human Services
Date Introduced 03/25/2019
Description

The bill enacts the Behavioral Health Care Coverage
Modernization Act to address issues related to coverage of behavioral,
mental health, and substance use disorder services under private health
insurance and the state medical assistance program (medicaid).
With regard to health insurance, the bill:
  • Specifies that mandatory insurance coverage for

behavioral, mental health, and substance use disorders
includes coverage for the prevention of, screening for, and
treatment of those disorders and must comply with the
federal Paul Wellstone and Pete Domenici Mental Health
Parity and Addiction Equity Act of 2008 (MHPAEA)
(section 3 of the bill);
  • Requires coverage for services for behavioral, mental
health, and substance use disorders to continue while a
claim for the coverage is under review until the carrier
notifies the covered person of the claim determination
(section 3);
  • Requires carriers to comply with treatment limitation
requirements specified in federal regulations and precludes
carriers from applying treatment limitations to behavioral,
mental health, and substance use disorder services that do
not apply to medical and surgical benefits (section 3);
  • Requires carriers to provide an adequate network of
providers that are able to provide behavioral, mental health,
and substance use disorder services and to establish
procedures to authorize treatment by nonparticipating
providers when a participating provider is not available
under network adequacy requirements (section 3);
  • Modifies the definition of behavioral, mental health, and
substance use disorder to include diagnostic categories
listed in the mental disorders section of the International
Statistical Classification of Diseases and Related Health
Problems, the Diagnostic and Statistical Manual of Mental
Disorders, or the Diagnostic Classification of Mental
Health and Developmental Disorders of Infancy and Early
Childhood (section 3);
  • Updates the required coverage related to alcohol use and
behavioral health screenings to reflect the current
requirements of that coverage as specified in
recommendations of the United States preventive services
task force (section 3);
  • Requires the commissioner of insurance (commissioner) to
disallow a carrier's requested rate increase for failure to
demonstrate compliance with the MHPAEA (section 5);
  • For purposes of denials of requests for reimbursement for
behavioral, mental health, or substance use disorder
services, requires carriers to include specified information
about the protections included in the MHPAEA, how to
contact the division of insurance or the office of the
ombudsman for behavioral health access to care (office)
related to possible violations of the MHPAEA, and the
right to request medical necessity criteria (section 6);
  • For health benefit plans issued or renewed on or after
January 1, 2020, requires carriers that provide coverage for
an annual physical examination as a preventive health care
service to also cover an annual mental wellness checkup to
the same extent the physical examination is covered
(section 8);
  • Requires carriers to submit an annual parity report to the
commissioner (section 9); and
  • Starting January 1, 2020, requires carriers that provide
prescription drug benefits for the treatment of substance
use disorders to provide coverage of any FDA-approved
prescription medication for treating substance use disorders
without prior authorization or step therapy requirements
and to place all covered substance use disorder prescription
medications on the lowest tier of the drug formulary, and
precludes those carriers from excluding coverage for those
medications and related services solely on the grounds that
they were court ordered (section 10).
With regard to medicaid, the bill:
  • Requires the department of health care policy and financing
(department) to ensure that medicaid covers behavioral,
mental health, and substance use disorder services to the
extent that medicaid covers a physical illness and complies
with the MHPAEA (section 11);
  • Requires the statewide system of community behavioral
health care in the managed care system to require managed
care entities (MCEs) to provide an adequate network of
providers of behavioral, mental health, and substance use
disorder services and to prohibit MCEs from denying
payment for medically necessary and covered treatment for
a covered behavioral health disorder diagnosis or a covered
substance use disorder on the basis that the covered
diagnosis is not primary (section 12);
  • Requires the department to make MCE annual network
adequacy plans public and to examine complaints from the
office regarding compliance with the requirements of the
bill or the MHPAEA (section 12);
  • Requires MCEs to include specified statements regarding
the applicability of the MHPAEA to the managed care
system in medicaid and how to contact the office regarding
possible violations of the MHPAEA (section 14);
  • Requires MCEs to submit specified data to the department
regarding behavioral health services utilization by groups
that experience health disparities, denial rates for
behavioral health services requiring prior authorization,
and behavioral health provider directories (section 15);
  • Requires the department to submit an annual parity report
to the specified committees of the general assembly
(section 15); and
  • Starting January 1, 2020, requires an MCE that provides
prescription drug benefits for the treatment of substance
use disorders to provide coverage of any FDA-approved
prescription medication for treating substance use disorders
without prior authorization or step therapy requirements
and precludes those MCEs from excluding coverage for
those medications and related services solely on the
grounds that they were court ordered (section 16).

Committee Reports
with Amendments
Full Text
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Fiscal Notes Fiscal Notes (08/01/2019) (most recent)  
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