Bill Text: MI HB5617 | 2019-2020 | 100th Legislature | Introduced
Bill Title: Human services; medical services; mental health parity and addiction equity compliance; provide for. Amends 1939 PA 280 (MCL 400.1 - 400.119b) by adding sec. 109n.
Spectrum: Slight Partisan Bill (Republican 3-1)
Status: (Introduced - Dead) 2020-03-17 - Bill Electronically Reproduced 03/17/2020 [HB5617 Detail]
Download: Michigan-2019-HB5617-Introduced.html
HOUSE BILL NO. 5617
March 12, 2020, Introduced by Reps. Whiteford,
Love, Calley and Brann and referred to the Committee on Health Policy.
A bill to amend 1939 PA 280, entitled
"The social welfare act,"
(MCL 400.1 to 400.119b) by adding section 109n.
the people of the state of michigan enact:
Sec. 109n. (1) The department, in
collaboration and coordination with contracted health plans and specialty
prepaid health plans, shall submit an annual report to the legislature and this
state's behavioral health advisory council, this state's medical care advisory
council, and this state's developmental disabilities council by March 1 of each
year that contains the following information:
(a) For each classification of benefits, identification of all financial requirements and quantitative treatment limitations that are applied to mental health and substance use disorder benefits and medical and surgical benefits, and a description of the process of how the department, contracted health plan, or specialty prepaid health plan assesses that each financial requirement and quantitative treatment limitation is not more restrictive for mental health and substance use disorder benefits than for the predominant financial requirement or quantitative treatment limitation of that type that is applied to substantially all medical and surgical benefits.
(b) A description of the process used to develop or select the medical necessity criteria for mental health and substance use disorder benefits and the process used to develop or select the medical necessity criteria for medical and surgical benefits.
(c) Identification of all NQTLs that are applied to both mental health and substance use disorder benefits and medical and surgical benefits within each classification of benefits. There must not be separate NQTLs that apply to mental health and substance use disorder benefits that do not apply to medical and surgical benefits within any classification of benefits.
(d) The results of an analysis that demonstrates that for the medical necessity criteria described in subdivision (b) and for each NQTL identified in subdivision (c), as written and in operation, the processes, strategies, evidentiary standards, or other factors used in applying the medical necessity criteria and each NQTL to mental health and substance use disorder benefits within each classification of benefits are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the medical necessity criteria and each NQTL to medical and surgical benefits within the corresponding classification of benefits. At a minimum, the results of the analysis must do all of the following:
(i) Identify the factors used to determine that an NQTL will apply to a benefit, including factors that were considered but rejected.
(ii) Identify and define the specific evidentiary standards used to define the factors and any other evidence relied on in designing each NQTL.
(iii) Provide the comparative analyses, including the results of the analyses, performed to determine that the processes and strategies used to design each NQTL, as written, and the processes and strategies used to apply the NQTL, as written, for mental health and substance use disorder benefits are comparable to, and are applied no more stringently than, the processes and strategies used to design each NQTL, as written, and the processes and strategies used to apply the NQTL, as written, for medical and surgical benefits.
(iv) Provide the comparative analyses, including the results of the analyses, performed to determine that the processes and strategies used to apply each NQTL, in operation, for mental health and substance use disorder benefits are comparable to, and are applied no more stringently than, the processes and strategies used to apply each NQTL, in operation, for medical and surgical benefits.
(v) Disclose the specific findings and conclusions reached by the department, in collaboration and coordination with contracted health plans and specialty prepaid health plans, that the results of the analyses in this section indicate that the department, contracted health plans, and specialty prepaid health plans are in compliance with this section, the Paul Wellstone and Pete Domenici mental health parity and addiction equity act of 2008, subtitle B of title V of division C of Public Law 110-343, and the regulations promulgated under that act, including 42 CFR 438.910 and 42 CFR 440.395, and any state law pertaining to any state medical assistance program that governs access to medications for the treatment of mental health conditions and substance use disorders.
(2) As used in this section, "NQTL" means nonquantitative treatment limitation.
Enacting section 1. This amendatory act takes effect 90 days after the date it is enacted into law.
