Bill Text: MI HB5620 | 2019-2020 | 100th Legislature | Introduced
Bill Title: Insurance; health insurers; certain annual reports of health care corporations relating to mental health parity; require. Amends 1980 PA 350 (MCL 550.1101 - 550.1704) by adding sec. 414c.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2020-03-17 - Bill Electronically Reproduced 03/12/2020 [HB5620 Detail]
Download: Michigan-2019-HB5620-Introduced.html
HOUSE BILL NO. 5620
March 12, 2020, Introduced by Reps. Love,
Calley, Cynthia Johnson, Brann and Whiteford and referred to the Committee
on Health Policy.
A bill to amend 1980 PA 350, entitled
"The nonprofit health care corporation reform act,"
(MCL 550.1101 to 550.1704) by adding section 414c.
the people of the state of michigan enact:
Sec. 414c. (1) By March 1, 2021, and
each March 1 after that date, a health care corporation shall submit a report
to the director of the department of insurance and financial services that
includes all of 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 insurer 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 nonquantitative treatment limitations that are applied to
both mental health and substance use disorder benefits and medical surgical
benefits within each classification of benefits.
(d)
The results of an analysis that demonstrates that for the medical necessity
criteria described in subdivision (a) and for each nonquantitative treatment
limitation identified in subdivision (b), as written and in operation, the
processes, strategies, evidentiary standards, or other factors used in applying
the medical necessity criteria and each nonquantitative treatment limitation 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 nonquantitative treatment limitation to
medical and surgical benefits within the corresponding classification of
benefits. At a minimum, the results of the analysis under this subdivision must
do all of the following:
(i) Identify the factors used to
determine that a nonquantitative treatment limitation 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 nonquantitative treatment limitation.
(iii) Provide the comparative analyses,
including the results of the analyses, performed to determine that the
processes and strategies used to design each nonquantitative treatment
limitation, as written, and the as-written processes and strategies used to
apply the nonquantitative treatment limitation to 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 nonquantitative
treatment limitation, as written, and the as-written processes and strategies
used to apply the nonquantitative treatment limitation to medical and surgical
benefits.
(iv) Provide the comparative analyses,
including the results of the analyses, preformed to determine that the
processes and strategies used to apply each nonquantitative treatment
limitation, 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 nonquantitative treatment limitation, in
operation, for medical and surgical benefits.
(v) Disclose the specific findings and
conclusions reached by the insurer that the results of the analyses under this
section indicate that the insurer is in compliance with this section and 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 its
implementing and related regulations, which include 45 CFR 146.136, 45 CFR
147.160, and 45 CFR 156.115(a)(3).
(2) A health care corporation shall not have any separate nonquantitative treatment limitations that apply to mental health and substance use disorder benefits but do not apply to medical and surgical benefits within any classification of benefits.
