Full Text of HB0068 100th General Assembly
HB0068ham001 100TH GENERAL ASSEMBLY | Rep. Lou Lang Filed: 3/16/2017
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| 1 | | AMENDMENT TO HOUSE BILL 68
| 2 | | AMENDMENT NO. ______. Amend House Bill 68 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The State Finance Act is amended by changing | 5 | | Section 5.872 as follows:
| 6 | | (30 ILCS 105/5.872)
| 7 | | Sec. 5.872. The Parity Advancement Education Fund. | 8 | | (Source: P.A. 99-480, eff. 9-9-15; 99-642, eff. 7-28-16.)
| 9 | | Section 10. The Illinois Insurance Code is amended by | 10 | | changing Sections 370c and 370c.1 as follows:
| 11 | | (215 ILCS 5/370c) (from Ch. 73, par. 982c)
| 12 | | Sec. 370c. Mental and emotional disorders.
| 13 | | (a) (1) On and after the effective date of this amendatory | 14 | | Act of the 100th General Assembly the effective date of this |
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| 1 | | amendatory Act of the 97th General Assembly ,
every insurer that | 2 | | which amends, delivers, issues, or renews group accident and | 3 | | health policies providing coverage for hospital or medical | 4 | | treatment or
services for illness on an expense-incurred basis | 5 | | shall provide offer to the
applicant or group policyholder | 6 | | subject to the insurer's standards of
insurability, coverage | 7 | | for reasonable and necessary treatment and services
for mental, | 8 | | emotional , or nervous , or substance use disorders or | 9 | | conditions , other than serious
mental illnesses as defined in | 10 | | item (2) of subsection (b), consistent with the parity | 11 | | requirements of Section 370c.1 of this Code.
| 12 | | (2) Each insured that is covered for mental, emotional, | 13 | | nervous, or substance use
disorders or conditions shall be free | 14 | | to select the physician licensed to
practice medicine in all | 15 | | its branches, licensed clinical psychologist,
licensed | 16 | | clinical social worker, licensed clinical professional | 17 | | counselor, licensed marriage and family therapist, licensed | 18 | | speech-language pathologist, or other licensed or certified | 19 | | professional at a program licensed pursuant to the Illinois | 20 | | Alcoholism and Other Drug Abuse and Dependency Act of
his | 21 | | choice to treat such disorders, and
the insurer shall pay the | 22 | | covered charges of such physician licensed to
practice medicine | 23 | | in all its branches, licensed clinical psychologist,
licensed | 24 | | clinical social worker, licensed clinical professional | 25 | | counselor, licensed marriage and family therapist, licensed | 26 | | speech-language pathologist, or other licensed or certified |
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| 1 | | professional at a program licensed pursuant to the Illinois | 2 | | Alcoholism and Other Drug Abuse and Dependency Act up
to the | 3 | | limits of coverage, provided (i)
the disorder or condition | 4 | | treated is covered by the policy, and (ii) the
physician, | 5 | | licensed psychologist, licensed clinical social worker, | 6 | | licensed
clinical professional counselor, licensed marriage | 7 | | and family therapist, licensed speech-language pathologist, or | 8 | | other licensed or certified professional at a program licensed | 9 | | pursuant to the Illinois Alcoholism and Other Drug Abuse and | 10 | | Dependency Act is
authorized to provide said services under the | 11 | | statutes of this State and in
accordance with accepted | 12 | | principles of his profession.
| 13 | | (3) Insofar as this Section applies solely to licensed | 14 | | clinical social
workers, licensed clinical professional | 15 | | counselors, licensed marriage and family therapists, licensed | 16 | | speech-language pathologists, and other licensed or certified | 17 | | professionals at programs licensed pursuant to the Illinois | 18 | | Alcoholism and Other Drug Abuse and Dependency Act, those | 19 | | persons who may
provide services to individuals shall do so
| 20 | | after the licensed clinical social worker, licensed clinical | 21 | | professional
counselor, licensed marriage and family | 22 | | therapist, licensed speech-language pathologist, or other | 23 | | licensed or certified professional at a program licensed | 24 | | pursuant to the Illinois Alcoholism and Other Drug Abuse and | 25 | | Dependency Act has informed the patient of the
desirability of | 26 | | the patient conferring with the patient's primary care
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| 1 | | physician and the licensed clinical social worker, licensed | 2 | | clinical
professional counselor, licensed marriage and family | 3 | | therapist, licensed speech-language pathologist, or other | 4 | | licensed or certified professional at a program licensed | 5 | | pursuant to the Illinois Alcoholism and Other Drug Abuse and | 6 | | Dependency Act has
provided written
notification to the | 7 | | patient's primary care physician, if any, that services
are | 8 | | being provided to the patient. That notification may, however, | 9 | | be
waived by the patient on a written form. Those forms shall | 10 | | be retained by
the licensed clinical social worker, licensed | 11 | | clinical professional counselor, licensed marriage and family | 12 | | therapist, licensed speech-language pathologist, or other | 13 | | licensed or certified professional at a program licensed | 14 | | pursuant to the Illinois Alcoholism and Other Drug Abuse and | 15 | | Dependency Act
for a period of not less than 5 years . | 16 | | (4) "Mental, emotional, nervous, or substance use disorder | 17 | | or condition" means a condition or disorder that involves a | 18 | | mental health condition or substance use disorder that falls | 19 | | under any of the diagnostic categories listed in the mental and | 20 | | behavioral disorders chapter of the current edition of the | 21 | | International Classification of Disease or that is listed in | 22 | | the most recent version of the Diagnostic and Statistical | 23 | | Manual of Mental Disorders.
| 24 | | (b) (1) (Blank). An insurer that provides coverage for | 25 | | hospital or medical
expenses under a group policy of accident | 26 | | and health insurance or
health care plan amended, delivered, |
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| 1 | | issued, or renewed on or after the effective
date of this | 2 | | amendatory Act of the 97th General Assembly shall provide | 3 | | coverage
under the policy for treatment of serious mental | 4 | | illness and substance use disorders consistent with the parity | 5 | | requirements of Section 370c.1 of this Code. This subsection | 6 | | does not apply to any group policy of accident and health | 7 | | insurance or health care plan for any plan year of a small | 8 | | employer as defined in Section 5 of the Illinois Health | 9 | | Insurance Portability and Accountability Act.
| 10 | | (2) (Blank). "Serious mental illness" means the following | 11 | | psychiatric illnesses as
defined in the most current edition of | 12 | | the Diagnostic and Statistical Manual
(DSM) published by the | 13 | | American Psychiatric Association:
| 14 | | (A) schizophrenia;
| 15 | | (B) paranoid and other psychotic disorders;
| 16 | | (C) bipolar disorders (hypomanic, manic, depressive, | 17 | | and mixed);
| 18 | | (D) major depressive disorders (single episode or | 19 | | recurrent);
| 20 | | (E) schizoaffective disorders (bipolar or depressive);
| 21 | | (F) pervasive developmental disorders;
| 22 | | (G) obsessive-compulsive disorders;
| 23 | | (H) depression in childhood and adolescence;
| 24 | | (I) panic disorder; | 25 | | (J) post-traumatic stress disorders (acute, chronic, | 26 | | or with delayed onset); and
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| 1 | | (K) anorexia nervosa and bulimia nervosa. | 2 | | (2.5) (Blank). "Substance use disorder" means the | 3 | | following mental disorders as defined in the most current | 4 | | edition of the Diagnostic and Statistical Manual (DSM) | 5 | | published by the American Psychiatric Association: | 6 | | (A) substance abuse disorders; | 7 | | (B) substance dependence disorders; and | 8 | | (C) substance induced disorders. | 9 | | (3) Unless otherwise prohibited by federal law and | 10 | | consistent with the parity requirements of Section 370c.1 of | 11 | | this Code, the reimbursing insurer that amends, delivers, | 12 | | issues, or renews a group or individual policy of accident and | 13 | | health insurance, a qualified health plan offered through the | 14 | | health insurance marketplace, or , a provider of treatment of | 15 | | mental, emotional, nervous, or
serious mental illness or | 16 | | substance use disorders or conditions disorder shall furnish | 17 | | medical records or other necessary data
that substantiate that | 18 | | initial or continued treatment is at all times medically
| 19 | | necessary. An insurer shall provide a mechanism for the timely | 20 | | review by a
provider holding the same license and practicing in | 21 | | the same specialty as the
patient's provider, who is | 22 | | unaffiliated with the insurer, jointly selected by
the patient | 23 | | (or the patient's next of kin or legal representative if the
| 24 | | patient is unable to act for himself or herself), the patient's | 25 | | provider, and
the insurer in the event of a dispute between the | 26 | | insurer and patient's
provider regarding the medical necessity |
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| 1 | | of a treatment proposed by a patient's
provider. If the | 2 | | reviewing provider determines the treatment to be medically
| 3 | | necessary, the insurer shall provide reimbursement for the | 4 | | treatment. Future
contractual or employment actions by the | 5 | | insurer regarding the patient's
provider may not be based on | 6 | | the provider's participation in this procedure.
Nothing | 7 | | prevents
the insured from agreeing in writing to continue | 8 | | treatment at his or her
expense. When making a determination of | 9 | | the medical necessity for a treatment
modality for mental, | 10 | | emotional, nervous, or serious mental illness or substance use | 11 | | disorders or conditions disorder , an insurer must make the | 12 | | determination in a
manner that is consistent with the manner | 13 | | used to make that determination with
respect to other diseases | 14 | | or illnesses covered under the policy, including an
appeals | 15 | | process. Medical necessity determinations for substance use | 16 | | disorders shall be made in accordance with appropriate patient | 17 | | placement criteria established by the American Society of | 18 | | Addiction Medicine. No additional criteria may be used to make | 19 | | medical necessity determinations for substance use disorders.
| 20 | | (4) A group health benefit plan amended, delivered, issued, | 21 | | or renewed on or after the effective date of this amendatory | 22 | | Act of the 100th General Assembly or an individual policy of | 23 | | accident and health insurance or a qualified health plan | 24 | | offered through the health insurance marketplace amended, | 25 | | delivered, issued, or renewed on or after the effective date of | 26 | | this amendatory Act of the 100th General Assembly the effective |
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| 1 | | date of this amendatory Act of the 97th General Assembly :
| 2 | | (A) shall provide coverage based upon medical | 3 | | necessity for the
treatment of a mental, emotional, | 4 | | nervous, or mental illness and substance use disorder or | 5 | | condition disorders consistent with the parity | 6 | | requirements of Section 370c.1 of this Code; provided, | 7 | | however, that in each calendar year coverage shall not be | 8 | | less than the following:
| 9 | | (i) 45 days of inpatient treatment; and
| 10 | | (ii) beginning on June 26, 2006 (the effective date | 11 | | of Public Act 94-921), 60 visits for outpatient | 12 | | treatment including group and individual
outpatient | 13 | | treatment; and | 14 | | (iii) for plans or policies delivered, issued for | 15 | | delivery, renewed, or modified after January 1, 2007 | 16 | | (the effective date of Public Act 94-906),
20 | 17 | | additional outpatient visits for speech therapy for | 18 | | treatment of pervasive developmental disorders that | 19 | | will be in addition to speech therapy provided pursuant | 20 | | to item (ii) of this subparagraph (A); and
| 21 | | (B) may not include a lifetime limit on the number of | 22 | | days of inpatient
treatment or the number of outpatient | 23 | | visits covered under the plan.
| 24 | | (C) (Blank).
| 25 | | (5) An issuer of a group health benefit plan or an | 26 | | individual policy of accident and health insurance or a |
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| 1 | | qualified health plan offered through the health insurance | 2 | | marketplace may not count toward the number
of outpatient | 3 | | visits required to be covered under this Section an outpatient
| 4 | | visit for the purpose of medication management and shall cover | 5 | | the outpatient
visits under the same terms and conditions as it | 6 | | covers outpatient visits for
the treatment of physical illness.
| 7 | | (5.5) An individual or group health benefit plan amended, | 8 | | delivered, issued, or renewed on or after the effective date of | 9 | | this amendatory Act of the 99th General Assembly shall offer | 10 | | coverage for medically necessary acute treatment services and | 11 | | medically necessary clinical stabilization services. The | 12 | | treating provider shall base all treatment recommendations and | 13 | | the health benefit plan shall base all medical necessity | 14 | | determinations for substance use disorders in accordance with | 15 | | the most current edition of the Treatment Criteria for | 16 | | Addictive, Substance-Related, and Co-Occurring Conditions | 17 | | established by the American Society of Addiction Medicine | 18 | | Patient Placement Criteria . The treating provider shall base | 19 | | all treatment recommendations and the health benefit plan shall | 20 | | base all medical necessity determinations for | 21 | | medication-assisted treatment in accordance with the most | 22 | | current Treatment Criteria for Addictive, Substance-Related, | 23 | | and Co-Occurring Conditions established by the American | 24 | | Society of Addiction Medicine. | 25 | | As used in this subsection: | 26 | | "Acute treatment services" means 24-hour medically |
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| 1 | | supervised addiction treatment that provides evaluation and | 2 | | withdrawal management and may include biopsychosocial | 3 | | assessment, individual and group counseling, psychoeducational | 4 | | groups, and discharge planning. | 5 | | "Clinical stabilization services" means 24-hour treatment, | 6 | | usually following acute treatment services for substance | 7 | | abuse, which may include intensive education and counseling | 8 | | regarding the nature of addiction and its consequences, relapse | 9 | | prevention, outreach to families and significant others, and | 10 | | aftercare planning for individuals beginning to engage in | 11 | | recovery from addiction. | 12 | | (6) An issuer of a group health benefit
plan may provide or | 13 | | offer coverage required under this Section through a
managed | 14 | | care plan.
| 15 | | (7) (Blank).
| 16 | | (8)
(Blank).
| 17 | | (9) With respect to all mental, emotional, nervous, or | 18 | | substance use disorders or conditions , coverage for inpatient | 19 | | treatment shall include coverage for treatment in a residential | 20 | | treatment center certified or licensed by the Department of | 21 | | Public Health or the Department of Human Services. | 22 | | (c) This Section shall not be interpreted to require | 23 | | coverage for speech therapy or other habilitative services for | 24 | | those individuals covered under Section 356z.15
of this Code. | 25 | | (d) With respect to a group or individual policy of | 26 | | accident and health insurance or a qualified health plan |
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| 1 | | offered through the health insurance marketplace, the The | 2 | | Department , and with respect to medical assistance, the | 3 | | Department of Healthcare and Family Services, shall each | 4 | | enforce the requirements of this Section and Sections 356z.23 | 5 | | and 370c.1 of this Code, the Paul Wellstone and Pete Domenici | 6 | | Mental Health Parity and Addiction Equity Act of 2008, 42 | 7 | | U.S.C. 18031(j), and any amendments to, and federal guidance or | 8 | | regulations issued under, those Acts, including, but not | 9 | | limited to, final regulations issued under the Paul Wellstone | 10 | | and Pete Domenici Mental Health Parity and Addiction Equity Act | 11 | | of 2008 and final regulations applying the Paul Wellstone and | 12 | | Pete Domenici Mental Health Parity and Addiction Equity Act of | 13 | | 2008 to Medicaid managed care organizations, the Children's | 14 | | Health Insurance Program, and alternative benefit plans. | 15 | | Specifically, the Department and the Department of Healthcare | 16 | | and Family Services shall take action: State and federal parity | 17 | | law, which includes | 18 | | (1) ensuring compliance by individual and group | 19 | | policies; | 20 | | (2) detecting violations of the law by individual and | 21 | | group policies proactively monitoring discriminatory | 22 | | practices ; | 23 | | (3) accepting, evaluating, and responding to | 24 | | complaints regarding such violations; | 25 | | (4) maintaining and regularly reviewing for possible | 26 | | parity violations a publicly available consumer complaint |
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| 1 | | log regarding mental, emotional, nervous, or substance use | 2 | | disorders or conditions coverage; | 3 | | (5) performing parity compliance pre-market and | 4 | | post-market conduct examinations of individual and group | 5 | | plans and policies, including, but not limited to, reviews | 6 | | of: | 7 | | (A) network adequacy using established criteria as | 8 | | set forth in federal and State requirements for medical | 9 | | assistance and individual or group health policies; | 10 | | (B) reimbursement rates; | 11 | | (C) denials of authorization, payment, and | 12 | | coverage; | 13 | | (D) prior authorization requirements; and | 14 | | (E) other specific criteria as shall be set forth | 15 | | in rules adopted by the Department. | 16 | | The findings and conclusions of the parity compliance | 17 | | market conduct examinations shall be made public and shall be | 18 | | reported to the General Assembly. | 19 | | The Director shall adopt rules to effectuate any provisions | 20 | | of the Paul Wellstone and Pete Domenici Mental Health Parity | 21 | | and Addiction Equity Act of 2008 that relate to the business of | 22 | | insurance. and ensuring violations are appropriately remedied | 23 | | and deterred. | 24 | | (e) Availability of plan information. | 25 | | (1) The criteria for medical necessity determinations | 26 | | made under a group health plan , an individual policy of |
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| 1 | | accident and health insurance, or a qualified health plan | 2 | | offered through the health insurance marketplace with | 3 | | respect to mental health or substance use disorder benefits | 4 | | (or health insurance coverage offered in connection with | 5 | | the plan with respect to such benefits) must be made | 6 | | available by the plan administrator (or the health | 7 | | insurance issuer offering such coverage) to any current or | 8 | | potential participant, beneficiary, or contracting | 9 | | provider upon request. | 10 | | (2) The reason for any denial under a group health | 11 | | benefit plan , an individual policy of accident and health | 12 | | insurance, or a qualified health plan offered through the | 13 | | health insurance marketplace (or health insurance coverage | 14 | | offered in connection with such plan or policy ) of | 15 | | reimbursement or payment for services with respect to | 16 | | mental , emotional, nervous, health or substance use | 17 | | disorders or conditions disorder benefits in the case of | 18 | | any participant or beneficiary must be made available | 19 | | within a reasonable time and in a reasonable manner and in | 20 | | readily understandable language by the plan administrator | 21 | | (or the health insurance issuer offering such coverage) to | 22 | | the participant or beneficiary upon request. | 23 | | (3) The following information under a group health | 24 | | benefit plan, an individual policy of accident and health | 25 | | insurance, or a qualified health plan offered through the | 26 | | health insurance marketplace (or health insurance coverage |
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| 1 | | offered in connection with such plan or policy) must be | 2 | | made available upon request: | 3 | | (A) a Summary Plan Description, or similar summary | 4 | | information; | 5 | | (B) the specific plan or policy language regarding | 6 | | the imposition of a nonquantitative treatment | 7 | | limitation (such as a preauthorization requirement); | 8 | | (C) the specific underlying processes, strategies, | 9 | | evidentiary standards, and other factors (including, | 10 | | but not limited to, all evidence) considered by the | 11 | | plan or policy (including factors that were relied upon | 12 | | and were rejected) in determining that a | 13 | | nonquantitative treatment limitation applies to any | 14 | | particular mental health or substance use disorder | 15 | | benefit; | 16 | | (D) information regarding the application of a | 17 | | nonquantitative treatment limitation to any medical or | 18 | | surgical benefits within any benefit classification at | 19 | | issue; | 20 | | (E) the specific underlying processes, strategies, | 21 | | evidentiary standards, and other factors (including, | 22 | | but not limited to, all evidence) considered by the | 23 | | plan or policy (including factors that were relied upon | 24 | | and were rejected) in determining the extent to which a | 25 | | nonquantitative treatment limitation applies to a | 26 | | particular medical or surgical benefit within a |
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| 1 | | benefit classification at issue; and | 2 | | (F) any analyses performed by the plan or under the | 3 | | policy as to how any nonquantitative treatment | 4 | | limitation complies with this Section and Sections | 5 | | 356z.23 and 370c.1 of this Code, the Paul Wellstone and | 6 | | Pete Domenici Mental Health Parity and Addiction | 7 | | Equity Act of 2008, 42 U.S.C. 18031(j), and any | 8 | | amendments to, and federal guidance or regulations | 9 | | issued under, those Acts, including, but not limited | 10 | | to, final regulations issued under the Paul Wellstone | 11 | | and Pete Domenici Mental Health Parity and Addiction | 12 | | Equity Act of 2008 and final regulations applying the | 13 | | Paul Wellstone and Pete Domenici Mental Health Parity | 14 | | and Addiction Equity Act of 2008 to Medicaid managed | 15 | | care organizations, the Children's Health Insurance | 16 | | Program, and alternative benefit plans. | 17 | | (f) As used in this Section, "group policy of accident and | 18 | | health insurance" and "group health benefit plan" includes (1) | 19 | | State-regulated employer-sponsored group health insurance | 20 | | plans written in Illinois or which purport to provide coverage | 21 | | for a resident of this State; and (2) State employee health | 22 | | plans. | 23 | | (g) The General Assembly decrees that it is the public | 24 | | policy of the State of Illinois to allow for private | 25 | | enforcement of mental, emotional, nervous, or substance use | 26 | | disorder or condition parity protections in a court of |
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| 1 | | competent jurisdiction, without administrative exhaustion or | 2 | | arbitration, even if otherwise required by an insurance policy. | 3 | | Members, patients, subscribers, enrollees, and providers | 4 | | (in-network and out-of-network) on behalf of members, | 5 | | patients, subscribers, and enrollees have the right to commence | 6 | | a civil action against any group health plan, an issuer of an | 7 | | individual policy of accident and health insurance, or a | 8 | | qualified health plan offered through the health insurance | 9 | | marketplace (or health insurance coverage offered in | 10 | | connection with such plan or policy) that violates the | 11 | | provisions of this Section, such that any member of a group | 12 | | health plan or an individual covered under a policy of accident | 13 | | and health insurance or a qualified health plan offered through | 14 | | the health insurance marketplace (or health insurance coverage | 15 | | offered in connection with such plan or policy) authorized | 16 | | representative of such plan or related entity, advocacy | 17 | | organization representing the interests of members of a health | 18 | | plan carrier or related entity, health care providers, or | 19 | | organization representing the interests of providers | 20 | | reimbursed by a health plan carrier or related entity, against | 21 | | which the violation is alleged, shall have standing to commence | 22 | | a civil action in a court of competent jurisdiction. | 23 | | The remedy under this Section is limited to a $5,000 | 24 | | penalty for each act or offense; injunctive relief; general and | 25 | | special damages, which may be trebled; restitution of premium; | 26 | | and attorney's fees and costs. |
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| 1 | | A violation consists of any violation of this Section or | 2 | | Section 370c.1 of this Code, the Paul Wellstone and Pete | 3 | | Domenici Mental Health Parity and Addiction Equity Act of 2008, | 4 | | 42 U.S.C. 18031(j), and any amendments to, and federal guidance | 5 | | or regulations issued under, those acts, including, but not | 6 | | limited to, final regulations issued under the Paul Wellstone | 7 | | and Pete Domenici Mental Health Parity and Addiction Equity Act | 8 | | of 2008 and final regulations applying the Paul Wellstone and | 9 | | Pete Domenici Mental Health Parity and Addiction Equity Act of | 10 | | 2008 to Medicaid Managed Care Organizations, Children's Health | 11 | | Insurance Programs (CHIP), and Alternative Benefit Plans. | 12 | | A violation of this Section shall not be contingent upon | 13 | | the plaintiff proving the medical necessity of any prescribed | 14 | | procedure, service, or medication. | 15 | | (Source: P.A. 99-480, eff. 9-9-15.) | 16 | | (215 ILCS 5/370c.1) | 17 | | Sec. 370c.1. Mental , emotional, nervous, or substance use | 18 | | disorder or condition health and addiction parity. | 19 | | (a) On and after the effective date of this amendatory Act | 20 | | of the 99th General Assembly, every insurer that amends, | 21 | | delivers, issues, or renews a group or individual policy of | 22 | | accident and health insurance or a qualified health plan | 23 | | offered through the Health Insurance Marketplace in this State | 24 | | providing coverage for hospital or medical treatment and for | 25 | | the treatment of mental, emotional, nervous, or substance use |
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| 1 | | disorders or conditions shall ensure that: | 2 | | (1) the financial requirements applicable to such | 3 | | mental, emotional, nervous, or substance use disorder or | 4 | | condition benefits are no more restrictive than the | 5 | | predominant financial requirements applied to | 6 | | substantially all hospital and medical benefits covered by | 7 | | the policy and that there are no separate cost-sharing | 8 | | requirements that are applicable only with respect to | 9 | | mental, emotional, nervous, or substance use disorder or | 10 | | condition benefits; and | 11 | | (2) the treatment limitations applicable to such | 12 | | mental, emotional, nervous, or substance use disorder or | 13 | | condition benefits are no more restrictive than the | 14 | | predominant treatment limitations applied to substantially | 15 | | all hospital and medical benefits covered by the policy and | 16 | | that there are no separate treatment limitations that are | 17 | | applicable only with respect to mental, emotional, | 18 | | nervous, or substance use disorder or condition benefits. | 19 | | (b) The following provisions shall apply concerning | 20 | | aggregate lifetime limits: | 21 | | (1) In the case of a group or individual policy of | 22 | | accident and health insurance or a qualified health plan | 23 | | offered through the Health Insurance Marketplace amended, | 24 | | delivered, issued, or renewed in this State on or after the | 25 | | effective date of this amendatory Act of the 99th General | 26 | | Assembly that provides coverage for hospital or medical |
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| 1 | | treatment and for the treatment of mental, emotional, | 2 | | nervous, or substance use disorders or conditions the | 3 | | following provisions shall apply: | 4 | | (A) if the policy does not include an aggregate | 5 | | lifetime limit on substantially all hospital and | 6 | | medical benefits, then the policy may not impose any | 7 | | aggregate lifetime limit on mental, emotional, | 8 | | nervous, or substance use disorder or condition | 9 | | benefits; or | 10 | | (B) if the policy includes an aggregate lifetime | 11 | | limit on substantially all hospital and medical | 12 | | benefits (in this subsection referred to as the | 13 | | "applicable lifetime limit"), then the policy shall | 14 | | either: | 15 | | (i) apply the applicable lifetime limit both | 16 | | to the hospital and medical benefits to which it | 17 | | otherwise would apply and to mental, emotional, | 18 | | nervous, or substance use disorder or condition | 19 | | benefits and not distinguish in the application of | 20 | | the limit between the hospital and medical | 21 | | benefits and mental, emotional, nervous, or | 22 | | substance use disorder or condition benefits; or | 23 | | (ii) not include any aggregate lifetime limit | 24 | | on mental, emotional, nervous, or substance use | 25 | | disorder or condition benefits that is less than | 26 | | the applicable lifetime limit. |
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| 1 | | (2) In the case of a policy that is not described in | 2 | | paragraph (1) of subsection (b) of this Section and that | 3 | | includes no or different aggregate lifetime limits on | 4 | | different categories of hospital and medical benefits, the | 5 | | Director shall establish rules under which subparagraph | 6 | | (B) of paragraph (1) of subsection (b) of this Section is | 7 | | applied to such policy with respect to mental, emotional, | 8 | | nervous, or substance use disorder or condition benefits by | 9 | | substituting for the applicable lifetime limit an average | 10 | | aggregate lifetime limit that is computed taking into | 11 | | account the weighted average of the aggregate lifetime | 12 | | limits applicable to such categories. | 13 | | (c) The following provisions shall apply concerning annual | 14 | | limits: | 15 | | (1) In the case of a group or individual policy of | 16 | | accident and health insurance or a qualified health plan | 17 | | offered through the Health Insurance Marketplace amended, | 18 | | delivered, issued, or renewed in this State on or after the | 19 | | effective date of this amendatory Act of the 99th General | 20 | | Assembly that provides coverage for hospital or medical | 21 | | treatment and for the treatment of mental, emotional, | 22 | | nervous, or substance use disorders or conditions the | 23 | | following provisions shall apply: | 24 | | (A) if the policy does not include an annual limit | 25 | | on substantially all hospital and medical benefits, | 26 | | then the policy may not impose any annual limits on |
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| 1 | | mental, emotional, nervous, or substance use disorder | 2 | | or condition benefits; or | 3 | | (B) if the policy includes an annual limit on | 4 | | substantially all hospital and medical benefits (in | 5 | | this subsection referred to as the "applicable annual | 6 | | limit"), then the policy shall either: | 7 | | (i) apply the applicable annual limit both to | 8 | | the hospital and medical benefits to which it | 9 | | otherwise would apply and to mental, emotional, | 10 | | nervous, or substance use disorder or condition | 11 | | benefits and not distinguish in the application of | 12 | | the limit between the hospital and medical | 13 | | benefits and mental, emotional, nervous, or | 14 | | substance use disorder or condition benefits; or | 15 | | (ii) not include any annual limit on mental, | 16 | | emotional, nervous, or substance use disorder or | 17 | | condition benefits that is less than the | 18 | | applicable annual limit. | 19 | | (2) In the case of a policy that is not described in | 20 | | paragraph (1) of subsection (c) of this Section and that | 21 | | includes no or different annual limits on different | 22 | | categories of hospital and medical benefits, the Director | 23 | | shall establish rules under which subparagraph (B) of | 24 | | paragraph (1) of subsection (c) of this Section is applied | 25 | | to such policy with respect to mental, emotional, nervous, | 26 | | or substance use disorder or condition benefits by |
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| 1 | | substituting for the applicable annual limit an average | 2 | | annual limit that is computed taking into account the | 3 | | weighted average of the annual limits applicable to such | 4 | | categories. | 5 | | (d) With respect to mental, emotional, nervous, or | 6 | | substance use disorders or conditions , an insurer shall use | 7 | | policies and procedures for the election and placement of | 8 | | mental, emotional, nervous, or substance use disorder or | 9 | | condition substance abuse treatment drugs on their formulary | 10 | | that are no less favorable to the insured as those policies and | 11 | | procedures the insurer uses for the selection and placement of | 12 | | other drugs for medical or surgical conditions and shall follow | 13 | | the expedited coverage determination requirements for | 14 | | substance abuse treatment drugs set forth in Section 45.2 of | 15 | | the Managed Care Reform and Patient Rights Act. | 16 | | (e) This Section shall be interpreted in a manner | 17 | | consistent with all applicable federal parity regulations | 18 | | including, but not limited to, the Paul Wellstone and Pete | 19 | | Domenici Mental Health Parity and Addiction Equity Act of 2008 , | 20 | | final regulations issued under the Paul Wellstone and Pete | 21 | | Domenici Mental Health Parity and Addiction Equity Act of 2008 | 22 | | and final regulations applying the Paul Wellstone and Pete | 23 | | Domenici Mental Health Parity and Addiction Equity Act of 2008 | 24 | | to Medicaid managed care organizations, the Children's Health | 25 | | Insurance Program, and alternative benefit plans at 78 FR | 26 | | 68240 . |
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| 1 | | (f) The provisions of subsections (b) and (c) of this | 2 | | Section shall not be interpreted to allow the use of lifetime | 3 | | or annual limits otherwise prohibited by State or federal law. | 4 | | (g) As used in this Section: | 5 | | "Financial requirement" includes deductibles, copayments, | 6 | | coinsurance, and out-of-pocket maximums, but does not include | 7 | | an aggregate lifetime limit or an annual limit subject to | 8 | | subsections (b) and (c). | 9 | | "Mental, emotional, nervous, or substance use disorder or | 10 | | condition" means a condition or disorder that involves a mental | 11 | | health condition or substance use disorder that falls under any | 12 | | of the diagnostic categories listed in the mental and | 13 | | behavioral disorders chapter of the current edition of the | 14 | | International Classification of Disease or that is listed in | 15 | | the most recent version of the Diagnostic and Statistical | 16 | | Manual of Mental Disorders. | 17 | | "Treatment limitation" includes limits on benefits based | 18 | | on the frequency of treatment, number of visits, days of | 19 | | coverage, days in a waiting period, or other similar limits on | 20 | | the scope or duration of treatment. "Treatment limitation" | 21 | | includes both quantitative treatment limitations, which are | 22 | | expressed numerically (such as 50 outpatient visits per year), | 23 | | and nonquantitative treatment limitations, which otherwise | 24 | | limit the scope or duration of treatment. A permanent exclusion | 25 | | of all benefits for a particular condition or disorder shall | 26 | | not be considered a treatment limitation. "Nonquantitative |
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| 1 | | treatment" means those limitations as described under federal | 2 | | regulations (26 CFR 54.9812-1). Nonquantitative treatment | 3 | | limitations include, but are not limited to: | 4 | | (1) medical management standards limiting or excluding | 5 | | benefits based on medical necessity or medical | 6 | | appropriateness, or based on whether the treatment is | 7 | | experimental or investigative; | 8 | | (2) formulary design for prescription drugs; | 9 | | (3) for plans with multiple network tiers (such as | 10 | | preferred providers and participating providers), network | 11 | | tier design; | 12 | | (4) standards for provider admission to participate in | 13 | | a network, including reimbursement rates; | 14 | | (5) plan methods for determining usual, customary, and | 15 | | reasonable charges; | 16 | | (6) refusal to pay for higher-cost therapies until it | 17 | | can be shown that a lower-cost therapy is not effective | 18 | | (also known as fail-first policies or step therapy | 19 | | protocols); | 20 | | (7) exclusions based on failure to complete a course of | 21 | | treatment; | 22 | | (8) restrictions based on geographic location, | 23 | | facility type, provider specialty, and other criteria that | 24 | | limit the scope or duration of benefits for services | 25 | | provided under the plan or coverage; | 26 | | (9) in-network and out-of-network geographic |
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| 1 | | limitations; | 2 | | (10) standards for providing access to out-of-network | 3 | | providers; | 4 | | (11) limitations on inpatient services for situations | 5 | | where the participant is a threat to self or others; | 6 | | (12) exclusions for court-ordered and involuntary | 7 | | holds; | 8 | | (13) experimental treatment limitations; | 9 | | (14) service coding; | 10 | | (15) exclusions for services provided by clinical | 11 | | social workers, physicians, licensed psychologists, | 12 | | licensed clinical professional counselors, licensed | 13 | | marriage and family therapists, licensed speech-language | 14 | | pathologists, or other licensed or certified professionals | 15 | | at a program licensed pursuant to the Illinois Alcoholism | 16 | | and Other Drug Abuse and Dependency Act; | 17 | | (16) network adequacy as set forth in federal and State | 18 | | requirements for medical assistance and individual or | 19 | | group health policies; and | 20 | | (17) provider reimbursement rates, including | 21 | | reimbursement rates for mental, emotional, nervous, or | 22 | | substance use disorder or condition screenings or | 23 | | diagnostic tests performed in primary care and integrated | 24 | | settings.
| 25 | | (h) The Department of Insurance shall implement the | 26 | | following education initiatives: |
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| 1 | | (1) By January 1, 2016, the Department shall develop a | 2 | | plan for a Consumer Education Campaign on parity. The | 3 | | Consumer Education Campaign shall focus its efforts | 4 | | throughout the State and include trainings in the northern, | 5 | | southern, and central regions of the State, as defined by | 6 | | the Department, as well as each of the 5 managed care | 7 | | regions of the State as identified by the Department of | 8 | | Healthcare and Family Services. Under this Consumer | 9 | | Education Campaign, the Department shall: (1) by January 1, | 10 | | 2017, provide at least one live training in each region on | 11 | | parity for consumers and providers and one webinar training | 12 | | to be posted on the Department website and (2) establish a | 13 | | consumer hotline to assist consumers in navigating the | 14 | | parity process by March 1, 2017 2016 . By January 1, 2018 | 15 | | the Department shall issue a report to the General Assembly | 16 | | on the success of the Consumer Education Campaign, which | 17 | | shall indicate whether additional training is necessary or | 18 | | would be recommended. | 19 | | (2) The Department, in coordination with the | 20 | | Department of Human Services and the Department of | 21 | | Healthcare and Family Services, shall convene a working | 22 | | group of health care insurance carriers, mental health | 23 | | advocacy groups, substance abuse patient advocacy groups, | 24 | | and mental health physician groups for the purpose of | 25 | | discussing issues related to the treatment and coverage of | 26 | | mental, emotional, nervous, or substance use abuse |
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| 1 | | disorders or conditions and compliance with parity | 2 | | obligations under State and federal law. Compliance shall | 3 | | be measured, tracked, and shared during the meetings of the | 4 | | working group and mental illness . The working group shall | 5 | | meet once before January 1, 2016 and shall meet | 6 | | semiannually thereafter. The Department shall issue an | 7 | | annual report to the General Assembly that includes a list | 8 | | of the health care insurance carriers, mental health | 9 | | advocacy groups, substance abuse patient advocacy groups, | 10 | | and mental health physician groups that participated in the | 11 | | working group meetings, details on the issues and topics | 12 | | covered, and any legislative recommendations developed by | 13 | | the working group . | 14 | | (3) Not later than August 1 of each year, the | 15 | | Department, in conjunction with the Department of | 16 | | Healthcare and Family Services, shall issue a joint report | 17 | | to the General Assembly and provide an educational | 18 | | presentation to the General Assembly. The report and | 19 | | presentation shall: | 20 | | (A) Cover the methodology the Departments use to | 21 | | check for compliance with the federal Paul Wellstone | 22 | | and Pete Domenici Mental Health Parity and Addiction | 23 | | Equity Act of 2008, 42 U.S.C. 18031(j), and any federal | 24 | | regulations or guidance relating to the compliance and | 25 | | oversight of the federal Paul Wellstone and Pete | 26 | | Domenici Mental Health Parity and Addiction Equity Act |
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| 1 | | of 2008 and 42 U.S.C. 18031(j). | 2 | | (B) Cover the methodology the Departments use to | 3 | | check for compliance with this Section and Sections | 4 | | 356z.23 and 370c of this Code. | 5 | | (C) Identify pre-market and post-market conduct | 6 | | examinations conducted or completed during the | 7 | | preceding 12-month period regarding compliance with | 8 | | parity in mental, emotional, nervous, and substance | 9 | | use disorder or condition benefits under State and | 10 | | federal laws and summarize the results of such market | 11 | | conduct examinations. This shall include: | 12 | | (i) the number of market conduct examinations | 13 | | initiated and completed; | 14 | | (ii) the benefit classifications examined by | 15 | | each market conduct examination; | 16 | | (iii) the subject matter of each market | 17 | | conduct examination, including quantitative and | 18 | | non-quantitative treatment limitations; and | 19 | | (iv) a summary of the basis for the final | 20 | | decision rendered in each market conduct | 21 | | examination. | 22 | | Individually identifiable information shall be | 23 | | excluded from the reports consistent with federal | 24 | | privacy protections. | 25 | | (D) Detail any educational or corrective actions | 26 | | the Departments have taken to ensure compliance with |
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| 1 | | the federal Paul Wellstone and Pete Domenici Mental | 2 | | Health Parity and Addiction Equity Act of 2008, 42 | 3 | | U.S.C. 18031(j), this Section, and Sections 356z.23 | 4 | | and 370c of this Code. | 5 | | (E) The report must be written in non-technical, | 6 | | readily understandable language and shall be made | 7 | | available to the public by, among such other means as | 8 | | the Departments find appropriate, posting the report | 9 | | on the Departments' websites. | 10 | | (4) In the event of uncertainty or disagreement with | 11 | | respect to the application, interpretation, | 12 | | implementation, or enforcement of the federal Paul | 13 | | Wellstone and Pete Domenici Mental Health Parity and | 14 | | Addiction Equity Act of 2008, 42 U.S.C. 18031(j), and any | 15 | | amendments to, and federal guidance or regulations issued | 16 | | under, those Acts, including, but not limited to, final | 17 | | regulations issued under the Paul Wellstone and Pete | 18 | | Domenici Mental Health Parity and Addiction Equity Act of | 19 | | 2008, final regulations applying the Paul Wellstone and | 20 | | Pete Domenici Mental Health Parity and Addiction Equity Act | 21 | | of 2008 to Medicaid managed care organizations, the | 22 | | Children's Health Insurance Program, and alternative | 23 | | benefit plans, Section 370c of this Code, and this Section, | 24 | | the Department and the Department of Healthcare and Family | 25 | | Services may request a formal written opinion from the | 26 | | Attorney General. The requests and opinions shall be issued |
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| 1 | | in accordance with State law and policies of the Attorney | 2 | | General. The Departments shall inform the public on their | 3 | | websites and in writing that any aggrieved beneficiary may | 4 | | ask the Departments to request a formal written opinion | 5 | | from the Attorney General. | 6 | | (i) The Parity Advancement Education Fund is created as a | 7 | | special fund in the State treasury. Moneys from fines and | 8 | | penalties collected from insurers for violations of this | 9 | | Section shall be deposited into the Fund. Moneys deposited into | 10 | | the Fund for appropriation by the General Assembly to the | 11 | | Department of Insurance shall be used for the purpose of | 12 | | providing financial support of the Consumer Education | 13 | | Campaign , parity compliance advocacy, and other initiatives | 14 | | that support parity implementation and enforcement on behalf of | 15 | | consumers and to the Department of Human Services for treatment | 16 | | grants . | 17 | | (j) An insurer that amends, delivers, issues, or renews a | 18 | | group or individual policy of accident and health insurance or | 19 | | a qualified health plan offered through the health insurance | 20 | | marketplace in this State providing coverage for hospital or | 21 | | medical treatment and for the treatment of mental, emotional, | 22 | | nervous, or substance use disorders or conditions shall submit | 23 | | an annual report to the Department, or with respect to medical | 24 | | assistance the Department of Healthcare and Family Services, on | 25 | | or before March 1 that contains the following information | 26 | | separately for inpatient in-network benefits, inpatient |
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| 1 | | out-of-network benefits, outpatient in-network benefits, | 2 | | outpatient out-of-network benefits, emergency care benefits, | 3 | | and prescription drug benefits in the case of accident and | 4 | | health insurance or qualified health plans, or inpatient, | 5 | | outpatient, emergency care, and prescription drug benefits in | 6 | | the case of medical assistance: | 7 | | (1) The number and percentage of times a benefit limit | 8 | | is exceeded for a mental, emotional, nervous, or substance | 9 | | use disorder or condition benefit and the number and | 10 | | percentage of times a benefit limit is exceeded for other | 11 | | medical benefits. | 12 | | (2) The number and percentage of times a co-pay or | 13 | | co-insurance limit for a mental, emotional, nervous, or | 14 | | substance use disorder or condition benefit is different | 15 | | from other medical benefits. | 16 | | (3) The number and percentage of claim denials for | 17 | | mental, emotional, nervous, or substance use disorder or | 18 | | condition benefits due to benefit limits and the number and | 19 | | percentage of claim denials for other medical benefits due | 20 | | to benefit limits. | 21 | | (4) The number and percentage of denials for | 22 | | experimental benefits or the use of unproven technology for | 23 | | a mental, emotional, nervous, or substance use disorder or | 24 | | condition benefit and the number and percentage of denials | 25 | | for experimental benefits or the use of unproven technology | 26 | | for other medical benefits. |
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| 1 | | (5) The number and percentage of administrative | 2 | | denials for no prior authorization for a mental, emotional, | 3 | | nervous, or substance use disorder or condition benefit and | 4 | | the number and percentage of administrative denials for no | 5 | | prior authorization for other medical benefits. | 6 | | (6) The number and percentage of denials due to a | 7 | | mental, emotional, nervous, or substance use disorder or | 8 | | condition benefit not being a covered benefit and the | 9 | | number and percentage of denials for other medical benefits | 10 | | not being a covered benefit. | 11 | | (7) The number and percentage of denials due to a | 12 | | mental, emotional, nervous, or substance use disorder or | 13 | | condition benefit not meeting medical necessity and the | 14 | | number and percentage of denials for other medical benefits | 15 | | not meeting medical necessity. | 16 | | (8) The number and percentage of denials upheld on | 17 | | appeal for a mental, emotional, nervous, or substance use | 18 | | disorder or condition benefit for not meeting medical | 19 | | necessity and the number and percentage of those for other | 20 | | medical benefits. | 21 | | (9) The number and percentage of denials due to a | 22 | | mental, emotional, nervous, or substance use disorder or | 23 | | condition benefit being denied administratively or any | 24 | | reason other than medical necessity. | 25 | | (10) The number and percentage of denials of mental, | 26 | | emotional, nervous, or substance use disorder or condition |
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| 1 | | benefits that went to the plan's external quality review | 2 | | organization, or similar reviewing body and were upheld and | 3 | | those that were overturned for medical necessity. | 4 | | (11) The number and percentage of continued stay review | 5 | | denials for mental, emotional, nervous, or substance use | 6 | | disorder or condition benefits. | 7 | | (12) The number and percentage of out-of-network | 8 | | claims for mental, emotional, nervous, or substance use | 9 | | disorder or condition benefits in each classification of | 10 | | benefits and the number and percentage of out-of-network | 11 | | claims for other medical benefits in each classification of | 12 | | benefits. | 13 | | (13) The number and percentage of emergency care claims | 14 | | for mental, emotional, nervous, or substance use disorder | 15 | | or condition benefits in each classification of benefits | 16 | | and the number and percentage of emergency care claims for | 17 | | other medical benefits in each classification of benefits. | 18 | | (14) The number and percentage of network directory | 19 | | providers in the outpatient benefits classification who | 20 | | filed no claims in the last 6 months of the plan's claims | 21 | | reporting period and all pertinent summary information and | 22 | | results respecting the tests and metrics the insurer used | 23 | | to assess the availability of each of the following types | 24 | | of mental, emotional, nervous, or substance use disorder or | 25 | | condition providers: MD/DO; doctoral level non-MD/DO and | 26 | | non-doctoral level non-MD/DO practitioners; and inpatient, |
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| 1 | | residential, and ambulatory provider organizations. | 2 | | (15) A summary of the plan's pharmacy management | 3 | | processes for mental, emotional, nervous, or substance use | 4 | | disorder or condition benefits compared to those for other | 5 | | medical benefits. | 6 | | (16) A summary of the internal processes of review for | 7 | | experimental benefits and unproven technology for mental, | 8 | | emotional, nervous, or substance use disorder or condition | 9 | | benefits and those for
other medical benefits. | 10 | | (17) A summary of how the plan's policies and | 11 | | procedures for utilization management for mental, | 12 | | emotional, nervous, or substance use disorder or condition | 13 | | benefits compare to those for other medical benefits. | 14 | | (18) The results of an analysis that demonstrates that | 15 | | for each nonquantitative treatment limitation, as written | 16 | | and in operation, the processes, strategies, evidentiary | 17 | | standards, or other factors used to apply each | 18 | | nonquantitative treatment limitation to mental, emotional, | 19 | | nervous, or substance use disorder or condition benefits | 20 | | are comparable to, and are applied no more stringently than | 21 | | the processes, strategies, evidentiary standards, or other | 22 | | factors used to apply each nonquantitative treatment | 23 | | limitation, as written and in operation, to medical and | 24 | | surgical benefits; at a minimum, the results of the | 25 | | analysis shall: | 26 | | (A) identify the factors used to determine that a |
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| 1 | | nonquantitative treatment limitation will apply to a | 2 | | benefit, including factors that were considered but | 3 | | rejected; | 4 | | (B) identify and define the specific evidentiary | 5 | | standards used to define the factors and any other | 6 | | evidentiary standards relied upon in designing each | 7 | | nonquantitative treatment limitation; | 8 | | (C) identify and describe the methods and analyses | 9 | | used, including the results of the analyses, to | 10 | | determine that the processes and strategies used to | 11 | | design each nonquantitative treatment limitation as | 12 | | written for mental, emotional, nervous, or substance | 13 | | use disorders or conditions benefits are comparable to | 14 | | and no more stringent than the processes and strategies | 15 | | used to design each nonquantitative treatment | 16 | | limitation as written for medical and surgical | 17 | | benefits; | 18 | | (D) identify and describe the methods and analyses | 19 | | used, including the results of the analyses, to | 20 | | determine that the processes and strategies used to | 21 | | apply each nonquantitative treatment limitation in | 22 | | operation for mental, emotional, nervous, or substance | 23 | | use disorders or conditions benefits are comparable to | 24 | | and no more stringent than the processes or strategies | 25 | | used to apply each nonquantitative treatment | 26 | | limitation in operation for medical and surgical |
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| 1 | | benefits; and | 2 | | (E) disclose the specific findings and conclusions | 3 | | reached by the insurer that the results of the analyses | 4 | | above indicate that the insurer is in compliance with | 5 | | this Section and the Mental Health Parity and Addiction | 6 | | Equity Act of 2008 and its implementing regulations, | 7 | | which includes 45 CFR 146.136 and any other relevant | 8 | | current or future regulations. | 9 | | (19) A certification signed by the insurer's chief | 10 | | executive officer and chief medical officer that states | 11 | | that the insurer has completed a comprehensive review of | 12 | | the administrative practices of the insurer for the prior | 13 | | calendar year for compliance with the necessary provisions | 14 | | of this Section and Sections 356z.23 and 370c of this Code, | 15 | | the federal Paul Wellstone and Pete Domenici Mental Health | 16 | | Parity and Addiction Equity Act of 2008, 42 U.S.C. | 17 | | 18031(j), and any amendments to, and federal guidance or | 18 | | regulations issued under, those Acts, including, but not | 19 | | limited to, final regulations issued under the Paul | 20 | | Wellstone and Pete Domenici Mental Health Parity and | 21 | | Addiction Equity Act of 2008 and final regulations applying | 22 | | the Paul Wellstone and Pete Domenici Mental Health Parity | 23 | | and Addiction Equity Act of 2008 to Medicaid managed care | 24 | | organizations, the Children's Health Insurance Program, | 25 | | and alternative benefit plans. | 26 | | (20) Any other information necessary to clarify data |
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| 1 | | provided in accordance with this Section requested by the | 2 | | Director, including information that may be proprietary or | 3 | | have commercial value. | 4 | | The Director shall not certify any policy of an insurer | 5 | | that fails to submit all data as required by this Section. | 6 | | (k) There is created within the Office of the Attorney | 7 | | General an Office of Consumer Advocate, which shall assist | 8 | | consumers, insureds, health care providers, and recipients in: | 9 | | (1) ensuring compliance with the requirements of this | 10 | | Section; | 11 | | (2) addressing issues related to insurance | 12 | | availability; | 13 | | (3) identifying and rectifying claims processing | 14 | | issues; | 15 | | (4) clarifying and resolving coverage questions; and | 16 | | (5) addressing other matters related to insurance | 17 | | consumer education and assistance. | 18 | | (Source: P.A. 99-480, eff. 9-9-15.)".
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