Bill Text: DE SB230 | 2017-2018 | 149th General Assembly | Draft
Bill Title: An Act To Amend Title 18 And Title 31 Of The Delaware Code Relating To Insurance
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Passed) 2018-08-29 - Signed by Governor [SB230 Detail]
Download: Delaware-2017-SB230-Draft.html
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SPONSOR: |
Sen. Townsend & Rep. Bentz |
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Sen. Henry |
DELAWARE STATE SENATE
149th GENERAL ASSEMBLY
SENATE BILL NO. 230
AN ACT TO AMEND TITLE 18 AND TITLE 31 OF THE DELAWARE CODE RELATING TO INSURANCE COVERAGE FOR SERIOUS MENTAL ILLNESS AND DRUG AND ALCOHOL DEPENDENCY.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:
Section 1. Amend § 3343, Title 18 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3343. Insurance coverage for serious mental illness.
(g) Reporting requirements.— All carriers must submit an annual report to the Commissioner on or
before July 1 of each year beginning in 2019 that contains the following information:
(1) A description of the process used to develop or select the medical necessity criteria for
mental illness and drug and alcohol dependencies benefits and the process used to develop or select the medical necessity criteria for medical and surgical benefits.
(2) Identification of all non-quantitative treatment limitations (NQTLs) that are applied to mental
illness and drug and alcohol dependencies benefits and medical and surgical benefits within each classification of benefits; there may be no separate NQTLs that apply to mental illness and drug and alcohol dependencies benefits that do not also apply to medical and surgical benefits within any classification of benefits.
(3) The results of an analysis that demonstrates that for the medical necessity criteria described
in paragraph (1) and for each NQTL identified in paragraph (2), 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 illness and drug and alcohol dependencies 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 shall:
a. Identify the factors used to determine that an NQTL will apply to a benefit, including factors that were
considered but rejected.
b. Identify and define the specific evidentiary standards used to define the factors and any other evidence
relied upon in designing each NQTL.
c. 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, for mental illness and drug and alcohol dependencies benefits are comparable to, and are applied no more stringently than, the processes and strategies used to design each NQTL, as written, for medical and surgical benefits.
d. 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 illness and drug and alcohol dependencies benefits are comparable to, and applied no more stringently than, the processes or strategies used to apply each NQTL, in operation, for medical and surgical benefits.
e. Disclose the specific findings and conclusions reached by the carrier that the results of the analyses
above indicate that the carrier is in compliance with this section and the Mental Health Parity and Addiction Equity Act of 2008 and its implementing regulations, which includes 45 CFR 146.136, 45 CFR 147.160, and any other related federal regulations found in the Code of Federal Regulations.
(g) (h) Nothing in this section shall be construed to limit or reduce any benefit, entitlement, or coverage conferred by § 3366 of this title including, but not limited to, provider and service eligibility.
Section 2. Amend Chapter 35, Title 18 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3571T. Mental Health Parity and Addiction Equity Act Reporting Requirements.
(a) All health insurers offering group health insurance coverage that provide mental illness and drug and
alcohol dependencies benefits must submit an annual report to the Commissioner on or before July 1 of each year beginning in 2019 that contains the following information:
(1) A description of the process used to develop or select the medical necessity criteria for
mental illness and drug and alcohol dependencies benefits and the process used to develop or select the medical necessity criteria for medical and surgical benefits.
(2) Identification of all non-quantitative treatment limitations (NQTLs) that are applied to mental
illness and drug and alcohol dependencies benefits and medical and surgical benefits within each classification of benefits; there may be no separate NQTLs that apply to mental illness and drug and alcohol dependencies benefits that do not also apply to medical and surgical benefits within any classification of benefits.
(3) The results of an analysis that demonstrates that for the medical necessity criteria described
in paragraph (1) and for each NQTL identified in paragraph (2), 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 illness and drug and alcohol dependencies 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 shall:
a. Identify the factors used to determine that an NQTL will apply to a benefit, including factors
that were considered but rejected.
b. Identify and define the specific evidentiary standards used to define the factors and any other
evidence relied upon in designing each NQTL.
c. 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, for mental illness and drug and alcohol dependencies benefits are comparable to, and are applied no more stringently than, the processes and strategies used to design each NQTL, as written, for medical and surgical benefits.
d. 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 illness and drug and alcohol dependencies benefits are comparable to, and applied no more stringently than, the processes or strategies used to apply each NQTL, in operation, for medical and surgical benefits.
e. Disclose the specific findings and conclusions reached by the insurer that the results of the
analyses above indicate that the carrier is in compliance with this section and the Mental Health Parity and Addiction Equity Act of 2008 and its implementing regulations, which includes 45 CFR 146.136 and any other related federal regulations found in the Code of Federal Regulations.
Section 3. Amend § 525, Title 31 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 525 Insurance coverage for serious mental illness and drug and alcohol dependency for recipients of aid under
§ 505(3) of this title.
(f) Reporting requirements.— Each carrier must submit a report to the Department on or before
July 1, 2019 , and any year thereafter during which the carrier makes significant changes to how it designs and applies its medical management protocols; the report must contain the following information:
(1) A description of the process used to develop or select the medical necessity criteria for
mental illness and drug and alcohol dependencies benefits and the process used to develop or select the medical necessity criteria for medical and surgical benefits.
(2) As requested by the Department, identification of select non-quantitative treatment
limitations (NQTLs) that are applied to mental illness and drug and alcohol dependencies benefits and medical and surgical benefits within each classification of benefits; there may be no separate NQTLs that apply to mental illness and drug and alcohol dependencies benefits that do not also apply to medical and surgical benefits within any classification of benefits.
(3) The results of an analysis that demonstrates that for the medical necessity criteria described
in paragraph (1) and for each NQTL identified in paragraph (2), 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 illness and drug and alcohol dependencies 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 shall:
a. Identify the factors used to determine that an NQTL will apply to a benefit, including factors
that were considered but rejected.
b. Identify and define the specific evidentiary standards used to define the factors and any other
evidence relied upon in designing each NQTL.
c. 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, for mental illness and drug and alcohol dependencies benefits are comparable to, and are applied no more stringently than, the processes and strategies used to design each NQTL, as written, for medical and surgical benefits.
d. 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 illness and drug and alcohol dependencies benefits are comparable to, and applied no more stringently than, the processes or strategies used to apply each NQTL, in operation, for medical and surgical benefits.
e. Disclose the specific findings and conclusions reached by the carrier that the results of the
analyses above indicate that the carrier is in compliance with this section and the Mental Health Parity and Addiction Equity Act of 2008 and its implementing regulations, which includes Subpart K of Part 438 of 42 CFR and any other related federal regulations found in the Code of Federal Regulations.
SYNOPSIS
This bill amends Title 18 of the Delaware Code, § 3343, by setting annual reporting requirements for insurance carriers with regard to coverage for serious mental illness and drug and alcohol dependencies.
This bill also amends Chapter 35, Title 18 of the Delaware Code by adding a new § 3571T to set annual reporting requirements for insurance carriers providing mental illness and drug and alcohol dependencies benefits, and the carriers' compliance with the Mental Health Parity and Addiction Equity Act of 2008.
This bill also amends Title 31 of the Delaware Code, § 525, by setting annual reporting requirements for insurance carriers regarding coverage for serious mental illness and drug and alcohol dependencies for recipients of public assistance.
Author: Senator Townsend
