(1)The state
department shall require each MCE contracted with the state department to
disclose all necessary information in order for the state department, by June 1,
2020, and by each June 1 thereafter, to submit a report to the health and insurance
committee and the public health care and human services committee of the house
of representatives, or their successor committees, and to the health and human
services committee of the senate, or its successor committee, regarding behavioral,
mental health, and substance use disorder parity. The report must contain the
following information for the prior calendar year:
(a)A description of the process used to develop or select the medical
necessity criteria for behavioral, mental health, and substance use disorder
benefits and the
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(1) The state
department shall require each MCE contracted with the state department to
disclose all necessary information in order for the state department, by June 1,
2020, and by each June 1 thereafter, to submit a report to the health and insurance
committee and the public health care and human services committee of the house
of representatives, or their successor committees, and to the health and human
services committee of the senate, or its successor committee, regarding behavioral,
mental health, and substance use disorder parity. The report must contain the
following information for the prior calendar year:
(a) A description of the process used to develop or select the medical
necessity criteria for behavioral, mental health, and substance use disorder
benefits and the process used to develop or select the medical necessity criteria
for medical and surgical benefits;
(b) Identification of all nonquantitative treatment limitations that are applied
to behavioral, mental health, and substance use disorder benefits and to medical
and surgical benefits within each classification of benefits and a statement that the
state is complying with 42 U.S.C. sec. 300gg-26 (a)(3)(A)(ii), as required by 42 U.S.C.
sec. 1396u-2 (b)(8), prohibiting the application of nonquantitative treatment
limitations to behavioral, mental health, and substance use disorder benefits that
do not apply to medical and surgical benefits within any classification of benefits;
(c) (I) The results of analyses demonstrating that, for the medical necessity
criteria described in subsection (1)(a) of this section and each nonquantitative
treatment limitation identified in subsection (1)(b) of this section, 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 benefits for behavioral, mental health, and substance use disorders
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.
(II) A report on the results of the analyses specified in this subsection (1)(c)
must, at a minimum:
(A) Identify the factors used to determine that a nonquantitative treatment
limitation 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 on in designing each nonquantitative
treatment limitation;
(C) 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 written processes and
strategies used to apply each nonquantitative treatment limitation for benefits for
behavioral, mental health, and substance use disorders are comparable to, and are
applied no more stringently than, the processes and strategies used to design and
apply each nonquantitative treatment limitation, as written, and the written
processes and strategies used to apply each nonquantitative treatment limitation
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
nonquantitative treatment limitation, in operation, for benefits for behavioral,
mental health, and substance use disorders 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;
and
(E) Disclose the specific findings and conclusions that indicate that the state
is in compliance with this section and with the MHPAEA.
(2) By October 1, 2019, for purposes of obtaining meaningful public input
during the assessment process described in subsection (1) of this section, the state
department shall seek input from stakeholders who may have competency in
benefit and delivery systems, utilization management, managed care contracting,
data and reporting, or compliance and audits. The state department shall consider
the input received in conducting the analyses and developing the report pursuant to
subsection (1) of this section.
(3) Notwithstanding section 24-1-136 (11)(a)(I), the reporting requirement
specified in this section continues indefinitely.
(4) The state department shall contract with an external quality review
organization at least annually to monitor MCEs' utilization management programs
and policies, including those that govern adverse determinations, to ensure
compliance with the MHPAEA. The quality review report must be readily available
to the public.