Arizona Statutes

SB 1523/ HB 2761.   For full text, click here. Amends AZ §§ 20-157-01 and 36-3504; Adds §§ 20-1138, 36-3436 and 36-3426.01.

The new law requires state to implement and enforce the Federal Parity Law provisions for commercially-insured group and individual policies.  Highlights include the following:

• Confidentiality. Implements confidentiality requirements for insurance information.
• Enforcement. Outlines subpoena powers for state regulators.
• Grievances/Appeals. Implements a number of consumer protections for appeals including the requirement that the Department of Insurance’s  telephone number be prominently listed on subscriber insurance card and the Department develop a consumer-friendly webpage which shall include a step-by-step guide with supporting information how a consumer can file an appeal or complaint.
• Parity Compliance and Reporting Requirements. Mandates that after January 1, 2020 covered insurers submit a report on each fully insured product network type to the Department of Insurance once every three years that contains the following:
  • Identify MH/SUD and medical/surgical medical necessity criteria.
  • Identify MH/SUD and medical/surgical nonquantitative treatment limitations (NQTLs) within each of six benefit classifications.
  • Disclose specific evidentiary standards used to define the factors and any other evidence relied upon in designing each NQTL.
  • Information demonstrating that the health plan has not applied any financial requirements (FR) or quantitative treatment limitations (QTLs) to MH/SUD coverage that is more restrictive than the predominant FR/QTL that is applied substantially all for medical/surgical coverage, with the following limited exceptions:
    • Multitiered prescription drug benefits,
    • Multiple network tiers, and
    • Office visit subclassifications.
  • Provide the comparative analyses showcasing both in writing and in operation the processes and strategies used to apply each MH/SUD NQTL, which shall be applied no more stringently than the processes and strategies used for medical/surgical NQTLs.
• Website Information. Requires the Department of Insurance to publish a web page that:
  • Provides consumer-friendly information about the Federal Parity Law and the state requirements, and how to file an insurance appeal or complaint.
  • Provides, on or before January 1, 2023, an aggregated summary of its analysis of the reports filed by health plan but with some confidentiality protections (e.g., health plans are not identified specifically).
• Children Protection. Implements MH/SUD coverage protections for minors including establishing a children’s behavioral health services fund.
• Advisory Committees:
  • Forms a mental health parity advisory committee.
  • Forms a suicide mortality review team to better understand, analyze and prevent suicides.

Adopted March 3, 2020.  See provisions for various implementation dates. 
Notes:   Insurers must submit updates annually to the Department of Insurance of any summary of changes regarding their parity compliance activities, including an attestation of compliance.  This new state parity law provides key aspects included in a Model State Parity Legislation developed by The Kennedy Forum and several other consumer advocacy groups.

This law requires insurance companies to comply with the Mental Health Parity and Addiction Equity Act of 2008. It requires insurers to submit detailed analyses on their compliance with the Federal Parity Act, including for each non-quantitative treatment limitation in each classification of care consistent with the six-step process. Reports on criteria must be submitted every three years, and regulators will then evaluate reports for compliance and enforce/respond accordingly. The law also outlines new requirements for member identification cards, including listing information that facilitates access to services or coverage. It also creates the Children’s Behavioral Services Fund and provides $8 million for behavioral health services for uninsured and/or underinsured children. The bill also prohibits insurance companies from denying coverage for services covered by a plan simply because they are delivered in an educational setting. Other provisions include a Mental Health Parity Advisory Committee and a Suicide Mortality Review Team.

ARIZ. REV. STAT. ANN. § 20-1376.05 requires disability insurance policies to cover health care services that are provided through telemedicine if those health care services would be covered had they been provided through in-person consultation. “Health care services” is defined in the statute as including mental health services, meaning insurers must provide equivalent coverage for mental health services provided through telemedicine. Disability insurers may impose deductibles, copays or coinsurance requirements as long as they do not exceed the deductible, copayment or coinsurance applicable to an in-person mental health consultation. However, disability insurers may limit the coverage to health care providers who are members of the insurer’s provider network.

A.R.S. § 36-2901.07 and A.R.S. §41-3803

A.R.S. § 36-2901.07 was amended to transfer the responsibility of establishing a diagnostic and evaluation program to which other state agencies can refer children who are not already enrolled and who may be in need of behavioral health services from the Department of Health Services to the administration acting through the regional behavioral health authorities. Additionally, A.R.S. §41-3803 was amended to transfer jurisdiction of the Human Rights Committee on the Mentally Ill from the Department of Health Services to the Arizona Health Care Cost Containment System.

The above referenced statutes were amended pursuant to AZ S. 1251.

Section 36-2901.07 is repealed if the below condition is met:

“1. From and after the date the federal medical assistance percentage pursuant to 42 United States Code section 1396d(y) or 1396d(z) that is applicable to this state is less than eighty per cent. 2. If the patient protection and affordable care act established pursuant to Public Law 111-148, as amended by the health care and education reconciliation act of 2010 pursuant to Public Law 111-152, is repealed. 3. If the maximum amount that can be assessed under section 36-2901.08, Arizona Revised Statutes, as added by this act, without causing a reduction in federal financial participation, in combination with the monies specified in section 36-2901.09, Arizona Revised Statutes, as added by this act, and any other monies appropriated for the costs for the populations specified in section 36-2901.08, subsection A, Arizona Revised Statutes, as added by this act, is insufficient to cover the costs described in section 36-2901.08, Arizona Revised Statutes, as added by this act. B. The Arizona health care cost containment system administration shall notify the director of the Arizona legislative council in writing of the effective date if: 1. The federal medical assistance percentage under 42 United States Code section 1396d(y) or 1396d(z) that is applicable to this state is less than eighty per cent. 2. The patient protection and affordable care act established pursuant to Public Law 111-148, as amended by the health care and education reconciliation act of 2010 pursuant to Public Law 111-152, is repealed. 3. The maximum amount that can be assessed under section 36-2901.08, Arizona Revised Statutes, as added by this act, without causing a reduction in federal financial participation, in combination with the monies specified in section 36-2901.09, Arizona Revised Statutes, as added by this act, and any other monies appropriated for the costs for the populations specified in section 36-2901.08, subsection A, Arizona Revised Statutes, as added by this act, is insufficient to cover the costs described in section 36 2901.08, Arizona Revised Statutes, as added by this act.”

As of August 9, 2017, the condition had not been met.