§ 27-13-7-14.2 — "Treatment of a mental illness or substance abuse"; "act"; "nonqualitative treatment limitations"; reporting and analysis requirements for individual and group contracts

Indiana § 27-13-7-14.2

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 13: HEALTH MAINTENANCE ORGANIZATIONS
• Ch. 7: Requirements for Group Contracts, Individual Contracts,

Text

2. (a) As used in this section, "treatment of
a mental illness or substance abuse" means:
(1) treatment for a mental illness, as defined in IC 12-7-2-130(1);
and
(2) treatment for drug abuse or alcohol abuse.
(b) As used in this section, "act" refers to the Paul Wellstone and
Pete Domenici Mental Health Parity and Addiction Act of 2008 and
any amendments thereto, plus any federal guidance or regulations
relevant to that act, including 45 CFR 146.136, 45 CFR 147.136, 45
CFR 147.160, and 45 CFR 156.115(a)(3).
(c) As used in this section, "nonquantitative treatment limitations"
refers to those limitations described in 26 CFR 54.9812-1, 29 CFR
2590.712, and 45 CFR 146.136.
(d) An individual contract or a group contract that provides
coverage of services for treatment of a mental illness or substance
abuse shall submit a report to the department not later than December
31 of each year that contains the following information:
(1) A description of the processes:
(A) used to develop or select the medical necessity criteria for
coverage of services for treatment of a mental illness or
substance abuse; and
(B) used to develop or select the medical necessity criteria for
coverage of services for treatment of other medical or surgical
conditions.
(2) Identification of all nonquantitative treatment limitations that
are applied to:
(A) coverage of services for treatment of a mental illness or
substance abuse; and
(B) coverage of services for treatment of other medical or
surgical conditions;
within each classification of benefits.
(e) There may be no separate nonquantitative treatment limitations
that apply to coverage of services for treatment of a mental illness or
substance abuse that do not apply to coverage of services for treatment
of other medical or surgical conditions within any classification of
benefits.
(f) An individual contract or a group contract that provides coverage
of services for treatment of a mental illness or substance abuse shall
also submit an analysis showing the insurer's compliance with this
section and the act to the department not later than December 31 of
each year. The analysis must do the following:
(1) Identify the factors used to determine that a nonquantitative
treatment limitation will apply to a benefit, including factors that
were considered but rejected.
(2) Identify and define the specific evidentiary standards used to
define the factors and any other evidence relied upon in designing
each nonquantitative treatment limitation.
(3) Provide the comparative analyses, including the results of the
analyses, performed to determine the following:
(A) That the processes and strategies used to design each
nonquantitative treatment limitation for coverage of services for
treatment of a mental illness or substance abuse are comparable
to, and applied no more stringently than, the processes and
strategies used to design each nonquantitative treatment
limitation for coverage of services for treatment of other
medical or surgical conditions.
(B) That the processes and strategies used to apply each
nonquantitative treatment limitation for treatment of a mental
illness or substance abuse are comparable to, and applied no
more stringently than, the processes and strategies used to apply
each nonquantitative limitation for treatment of other medical
or surgical conditions.
(g) The department shall adopt rules to ensure compliance with this
section and the applicable provisions of the act.

Legislative History

As added by P.L.103-2020, SEC.5.