Bill Text: AZ HB2128 | 2011 | Fiftieth Legislature 1st Regular | Introduced
Bill Title: Insurance; mental health coverage; parity
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2011-01-19 - Referred to House BI Committee [HB2128 Detail]
Download: Arizona-2011-HB2128-Introduced.html
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REFERENCE TITLE: insurance; mental health coverage; parity |
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State of Arizona House of Representatives Fiftieth Legislature First Regular Session 2011
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HB 2128 |
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Introduced by Representative Patterson
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AN ACT
Amending section 20‑2322, Arizona Revised Statutes; relating to accountable health plans.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 20-2322, Arizona Revised Statutes, is amended to read:
20-2322. Mental health services and benefits; definitions
A. Beginning on January 1, 1998, any health benefits plan that is offered by an accountable health plan and that provides services or health benefits that include mental health services or mental health benefits shall comply with this section.
B. If the health benefits plan does not include an aggregate lifetime limit on substantially all health services or health benefits that are not related to mental health services or mental health benefits, the health benefits plan shall not impose any aggregate lifetime limit on mental health services or mental health benefits. If the health benefits plan includes an aggregate lifetime limit on substantially all health services or health benefits that are not related to mental health services or mental health benefits, the health benefits plan shall either:
1. Apply the applicable lifetime limit to both the health services or health benefits that are not related to mental health services or mental health benefits and to the mental health services or mental health benefits.
2. Not include an aggregate lifetime limit on mental health services or mental health benefits that is less than the applicable lifetime limit for health services or health benefits that are not related to mental health services or mental health benefits.
C. If the health benefits plan does not include an aggregate annual limit on substantially all health services or health benefits that are not related to mental health services or mental health benefits, the health benefits plan shall not impose any aggregate annual limit on mental health services or mental health benefits. If the health benefits plan includes an aggregate annual limit on substantially all health services or health benefits that are not related to mental health services or mental health benefits, the health benefits plan shall either:
1. Apply the applicable annual limit to both the health services or health benefits that are not related to mental health services or mental health benefits and to the mental health services or mental health benefits.
2. Not include any aggregate annual limit on mental health services or mental health benefits that is less than the applicable annual limit for health services or health benefits that are not related to mental health services or mental health benefits.
D. Except as provided in subsections A, B and C, this section does not prevent an accountable health plan that offers a health benefits plan that provides mental health services or mental health benefits from imposing terms and conditions, including cost sharing, limits on the number of visits or days of coverage or requirements relating to medical necessity in relation to the amount, duration or scope of coverage for mental health services or mental health benefits under the health benefits plan. An accountable health plan that offers a health benefits plan that provides mental health services or mental health benefits shall not impose any treatment limitations or financial requirements with respect to the mental health services or mental health benefits coverage unless comparable treatment limitations or financial requirements are imposed on the health services or health benefits that are not related to mental health services or mental health benefits. Nothing in this section requires an accountable health plan to:
1. Offer a health benefits plan that provides mental health services or mental health benefits.
2. Comply with this section in connection with any health benefits plan offered to a small employer.
3. Comply with this section if that compliance under the health benefits plan offered by the accountable health plan would result in an increase in the cost to the health benefits plan of at least one two per cent in the first year and at least one per cent in any subsequent year.
E. The requirements of this section apply separately to each health benefits plan offered by an accountable health plan and shall be consistent with title VII of the health insurance portability and accountability act of 1996 (P.L. 104‑204; 110 Stat. 2944) and 45 Code of Federal Regulations part 146.
F. Mental health services or mental health benefits do not include benefits for the treatment of substance abuse or chemical dependency.
G. F. For the purposes of this section:
1. "Aggregate annual limit" means a dollar limitation on the total amount that may be paid in a twelve month period for benefits or services under a health benefits plan for an individual who is covered under a health benefits plan.
2. "Aggregate lifetime limit" means a dollar limitation on the total amount that may be paid for benefits or services under a health benefits plan for an individual who is covered under a health benefits plan.
3. "Financial requirements" include:
(a) Deductibles.
(b) Coinsurance.
(c) Copayments.
(d) Other cost sharing requirements.
4. "Mental health benefits" means benefits with respect to services, as defined under the terms and conditions of the health benefits plan, for all categories of mental health disorders or conditions that involve mental illness or substance related disorders that fall under any of the diagnostic categories listed in the mental disorders section of the international classification of disease, if these services are included as part of an authorized treatment plan according to standard protocols and meet the health benefits plan or issuer's medical necessity criteria.
5. "Treatment limitations" means limitations on the frequency of treatment or the number of visits or days of coverage or other similar limits on the duration or scope of treatment under the health benefits plan.
