REFERENCE TITLE: mental health; parity; advisory committee
State of Arizona
House of Representatives
Second Regular Session
Representatives Epstein: Andrade, Blanc, Butler, Cano, DeGrazia, Engel, Fernandez, Friese, Gabaldón, Jermaine, Lieberman, Longdon, Meza, Pawlik, Peten, Powers Hannley, Rodriguez, Salman, Sierra, Teller, Terán, Tsosie
amending section 20‑157.01, Arizona Revised Statutes; amending title 20, chapter 5, article 1, Arizona Revised Statutes, by adding section 20‑1138; amending title 20, Arizona Revised Statutes, by adding chapter 28; appropriating monies; relating to mental health.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 20-157.01, Arizona Revised Statutes, is amended to read:
20-157.01. Confidentiality of insurer files and records; access by director; definition
A. Pursuant to the director's authority under sections 20‑156, 20‑157, 20‑160, and 20‑466 and 20‑3502, an insurer shall comply with a request to produce any documents, reports or other materials, whether maintained in written or electronic format, from an insurer's claim file or an insurer's record that is required to comply with chapter 28, article 1 of this title.
B. Any documents, reports or other materials that are provided to the director pursuant to this section are confidential and are not subject to disclosure, including discovery or subpoena, unless the subpoena is issued by the attorney general or a county attorney or by a court at the request of the attorney general, a county attorney or any other law enforcement agency. The director may only disclose the information only to a state or federal agency or officer pursuant to a lawful request, subpoena or formal discovery procedure. If the requesting party cannot warrant confidentiality pursuant to section 20‑158, subsection I, the information that is provided pursuant to discovery, subpoena or lawful request as provided for in this subsection remains confidential. The director shall make reasonable efforts to notify an insurer of any request for a subpoena for documents, reports or other materials in an insurer insurer's claim file or other record that are produced by the insurer pursuant to this section so that the insurer may assert, in a court of competent jurisdiction, any applicable privileges.
C. The director may use the documents, reports or other materials in the furtherance of any regulatory action brought by the director or in actions brought against the director.
D. For the purposes of this section, "insurer claim file" includes medical records, repair estimates, adjuster notes, insurance policy provisions, recordings or transcripts of witness interviews and any other records regarding coverage, settlement, payment or denial or adjustment of a claim asserted under an insurance policy.
Sec. 2. Title 20, chapter 5, article 1, Arizona Revised Statutes, is amended by adding section 20-1138, to read:
20-1138. Health insurance policies; member identification cards; applicability
A. An identification card that includes information facilitating a subscriber's, enrollee's or insured's access to services or coverage under an individual or group health insurance contract, evidence of coverage or policy issued or renewed in this state by a hospital and medical service corporation, health care services organization or disability insurer must prominently display the letters "AZDIFI" in capital letters on the bottom front of the identification card and a telephone number that a subscriber, enrollee or insured may call for customer assistance.
B. This section applies to identification cards for any individual or group contract, evidence of coverage or policy issued or renewed from and after December 31, 2021.
Sec. 3. Title 20, Arizona Revised Statutes, is amended by adding chapter 28, to read:
MENTAL HEALTH PARITY
ARTICLE 1. GENERAL PROVISIONS
In this chapter, unless the context otherwise requires:
1. "Classification of benefits" means the following classifications of benefits provided by a health plan:
(a) Inpatient, in‑network.
(b) Inpatient, out‑of‑network.
(c) Outpatient, in‑network.
(d) Outpatient, out‑of‑network.
(e) Emergency care.
(f) Prescription benefits.
2. "Health care insurer" means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or hospital, medical, dental and optometric service corporation that issues a health plan in this state.
3. "Health plan" means an individual health plan or accountable health plan that provides mental health services or mental health benefits, that finances or provides covered health care services, that is issued by a health care insurer in this state and that is subject to the mental health parity and addiction equity act.
4. "MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT" MEANS THE MENTAL HEALTH PARITY AND ADDICTION equity ACT OF 2008 (42 UNITED STATES CODE SECTION 300gg-26) and implementing regulations.
5. "Product network type" means the network model associated with the type of health plan under which covered health care is delivered, such as a health care services organization, preferred provider network organization, point of service plan or indemnity plan.
6. "Treatment limits":
(a) Means limits on benefits based on the frequency of treatment, number of visits, days of coverage, days in a waiting period or other similar limits on the scope or duration of treatment.
(b) Includes both quantitative treatment limits that are expressed numerically and nonquantitative treatment limits that otherwise limit the scope or duration of benefits for treatment under a health plan.
(c) Does not include a permanent exclusion of all benefits for a particular condition or disorder.
20-3502. Compliance with federal law; report
A. Each health care insurer that issues a health plan in this state shall comply with the mental health parity and addiction equity act.
B. After January 1, 2022, on a date specified by the director, each health care insurer that issues a health plan in this state shall submit a report to the department for each fully insured product network type the health care insurer issues. If the health care insurer determines that the information to be reported varies by network or plan, or varies in the individual, small group or large group market, the health care insurer must submit a report for each variation. Each report must do the following:
1. Describe the process that is 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.
2. Identify all nonquantitative treatment limits that are applied to mental health and substance use disorder benefits and all nonquantitative treatment limits that are applied to medical and surgical benefits within each classification of benefits.
3. Demonstrate through analysis that for any nonquantitative treatment limit applied to mental health and substance use disorder benefits in a classification of benefits, as written and in operation, any process, strategy, evidentiary standard or other factor used in applying the nonquantitative treatment limit to mental health and substance use disorder benefits in the classification are comparable to, and applied not more stringently than, any process, strategy, evidentiary standard or other factor used in applying the treatment limit for medical and surgical benefits in the classification.
C. In addition to analyzing the reports prescribed in subsection B of this section, the department shall also evaluate health plan compliance with the standards related to financial requirements and quantitative treatment limits described in this section. The department shall perform this analysis during its review of required health care insurer form filings, but may also require a health care insurer to submit additional data relating to its methods for complying with financial requirements and quantitative treatment limit standards. The department may collect and analyze data for each health care insurer's large group plans through a separate, consolidated report.
D. The health plan may not apply any financial requirement or quantitative treatment limit to mental health and substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or quantitative treatment limit of that type applied to substantially all medical and surgical benefits in the same classification, unless the requirement or treatment limit is modified by one of the following exceptions:
1. Multitiered prescription drug benefits. If a health plan applies different levels of financial requirements to different tiers of prescription drug benefits that are based on reasonable factors determined in accordance with the requirements for nonquantitative treatment limits and without regard to whether a drug is generally prescribed with respect to medical and surgical benefits or with respect to mental health or substance use disorder benefits, the health plan satisfies the parity requirements of this section with respect to prescription drug benefits. For the purposes of this paragraph, "reasonable factors" include cost, efficacy, generic versus brand name and mail order versus pharmacy pick up.
2. Multiple network tiers. If a health plan provides benefits through multiple tiers of in‑network providers, including an in‑network tier of preferred providers with more generous cost sharing to participants than a separate in‑network tier of participating providers, the health plan may divide its benefits provided on an in‑network basis into subclassifications that reflect network tiers, if the tiering is based on reasonable factors determined in accordance with the requirements for nonquantitative treatment limits and without regard to whether a provider provides services with respect to medical and surgical benefits or mental health or substance use disorder benefits in any subclassification that is more restrictive than the predominant financial requirement or treatment limit that applies to substantially all medical and surgical benefits in the subclassification.
3. Subclassifications allowed for office visits that are separate from other outpatient services. For the purposes of applying the financial requirements and treatment limits prescribed by this section, a health plan may divide its benefits provided on an outpatient basis into the two subclassifications described in this paragraph. After the subclassifications are established, the health plan or health care insurer may not impose any financial requirement or quantitative treatment limit on mental health or substance use disorder benefits in any subclassification that is more restrictive than the predominant financial requirement or quantitative treatment limit that applies to substantially all medical and surgical benefits in the subclassification. Subclassifications for generalists and specialists are prohibited. Only the following two subclassifications are allowed under this paragraph:
(a) Office and physician visits.
(b) All other outpatient items and services, including outpatient surgery, facility charges for day treatment centers, laboratory charges or other similar medical items.
E. A health insurer shall file the report required by subsection b of this section once every three years. In years in which the report required by subsection B of this section is not required to be filed, the health care insurer shall file a summary of changes made to the medical necessity criteria and nonquantitative treatment limits and a written attestation that specifies that the health care insurer is in compliance with the mental health parity and addiction equity act. The department may require the health care insurer to respond to additional questions that are related to the summary of changes. Three years after the health care insurer submits an original report required by subsection B of this section or an updated or refiled report described in this subsection, the health care insurer may either:
1. File an updated report.
2. Resubmit the health care insurer's currently filed report if the health care insurer files a written attestation to the department that specifies that there have been no changes.
F. Except as otherwise provided in this section, if a health care insurer provided the information required by this section in an existing filing or report, the department may not require the health care insurer to submit any additional filing or report. the department shall analyze the information required by this section that the health care insurer previously submitted in an existing filing or report to determine compliance with the report required by this section. The department may establish by rule the terms regarding any required resubmittal of information.
G. All documents, reports or other materials provided to the director pursuant to this section are confidential and are not subject to disclosure. Section 20‑157.01, subsection B applies to this section.
20-3503. Enforcement and oversight
A. The department shall enforce this chapter.
B. On or before January 1, 2021, the department shall develop a web page that provides the following information in nontechnical and readily understandable language:
1. Consumer‑friendly information concerning the scope and applicability of the mental health parity and addiction equity act and the mental health parity requirements that apply to health care insurers that issue health plans in this state.
2. A step‑by‑step guide with supporting information that explains how consumers can file an appeal or complaint with the department concerning an alleged violation of this chapter.
C. On or before January 1, 2022, the department shall post to the web page prescribed in subsection B of this section an aggregated summary of its analysis of the reports filed by health care insurers pursuant to section 20‑3502, subsection B, including any conclusions regarding industry compliance with the mental health parity and addiction equity act. The department may not post any information that:
1. Contains any proprietary or confidential information of a health care insurer.
2. enables a person to determine the identity of a health care insurer.
D. Beginning in 2022, the department shall include in its annual report a summary of all stakeholder outreach and regulatory activity related to the implementation, oversight and enforcement of the mental health parity and addiction equity act and the requirements of this chapter.
A. Notwithstanding any other provision of this title, any health care insurer that issues a health plan in this state that includes mental health or substance use disorder benefits may not deny any claim for mental health or substance use disorder benefits for a minor solely on grounds that the mental health or substance use disorder service was provided in a school or other educational setting or ordered by a court if the service was provided by an in‑network provider or by an out‑of‑network provider only as allowed by the health plan that covers the subscriber, enrollee or insured.
B. This section does not require a health care insurer to approve a claim or provide reimbursement for a mental health or substance use disorder service provided by an out‑of‑network provider except AS ALLOWED BY THE HEALTH PLAN THAT COVERS THE SUBSCRIBER, ENROLLEE OR INSURED.
C. A health care insurer may require that any mental health or substance use disorder service offered by a mental health provider in an educational setting be provided in a facility or location that is appropriate for the type of service provided and in a manner that complies with applicable laws governing the provision of health care services, including privacy laws.
20-3505. Mental health parity advisory committee; members; committee termination
A. The mental health parity advisory committee is established to advise the directors of the department of insurance and FINANCIAL institutions and department of health services relating to matters pertinent to mental health parity, including recommendations related to case management, discharge planning and expedited review and appeals processes for cases involving suicidal ideation. The director of the department of insurance and financial institutions shall appoint the following members to the committee:
1. Four members who represent health care insurers.
2. At least one member and up to three members, if available, each of whom is a licensed behavioral health services provider.
3. Two members who represent a behavioral health advocacy organization.
4. At least two members who have been affected by suicide, substance use or a mental health disorder.
B. The director of the Arizona health care cost containment system or the director's designee may serve in an advisory capacity.
C. The committee established by this section ends on July 1, 2028 pursuant to section 41-3103.
Sec. 4. Rulemaking; department of insurance and financial institutions
A. On or before January 1, 2022, the department of insurance and financial institutions shall adopt by rule both of the following:
1. Forms or worksheets that health care insurers must use to prepare the reports required by section 20‑3502, Arizona Revised Statutes, as added by this act.
2. Standards to determine compliance with the mental health parity and addiction equity act.
B. Notwithstanding subsection A of this section, the department of insurance and financial institutions may also allow health care insurers to demonstrate compliance with section 20‑3502, Arizona Revised Statutes, as added by this act, by other means acceptable to the department.
C. In developing the forms, worksheets or other means that health care insurers must use to prepare the reports required by section 20‑3502, Arizona Revised Statutes, as added by this act, the department of insurance and financial institutions shall:
1. Conduct workshops and listening sessions to seek and obtain input from stakeholders, including health care insurers, behavioral health providers, advocacy organizations and individuals who have been impacted by mental health or substance use disorders.
2. Review the United States department of labor's self‑compliance tool for the mental health parity and addiction equity act and other reasonable and applicable resources.
Sec. 5. Rulemaking; department of health services
A. The department of health services shall adopt rules relating to discharging patients who have attempted suicide or exhibit suicidal ideation from inpatient care at a health care institution. The rules shall include protocols based on best practices for requiring health care institutions to implement discharge protocols and provide information to patients and caregivers before and at discharge.
B. The rules shall address the following topics:
1. The availability and contact information of age appropriate crisis services.
2. Information and referrals to the next appropriate level of treatment and care after discharge, including scheduling treatment when practicable.
3. Information on review and appeals processes, including referring patients and caregivers to the information on the department of insurance and financial institution's website relating to how to challenge an adverse decision by a health care insurer or health plan.
4. Conducting a suicide assessment before discharging a patient and informing the patient and caregivers of the results.
C. Notwithstanding any other law, for the purposes of this section, the department of health services is exempt from the rulemaking requirements of title 41, chapter 6, Arizona Revised Statutes, for eighteen months after the effective date of this section, except that the department shall provide public notice and an opportunity for public comment on proposed rules at least sixty days before the rules are amended or adopted.
Sec. 6. Appropriation; department of insurance and financial institutions; exemption
A. The sum of $200,000 and one FTE position are appropriated from the state general fund in fiscal year 2020-2021 to the department of insurance and financial institutions to administer title 20, chapter 28, Arizona Revised Statutes, as added by this act.
B. The appropriation made in subsection A of this section is exempt from the provisions of section 35-190, Arizona Revised Statutes, relating to lapsing of appropriations.