Pennsylvania Legislation

HB115 amends 40 Pa C.S. by adding a new chapter, chapter 39, to require all insurers that issue or administer a health insurance policy or health plan, including a policy or plan in which mental health or substance use disorder benefits are managed by an entity other than the insurer, and are subject to the jurisdiction the Insurance Department, to file with the Insurance Department a written certification attesting the insurer has reviewed all plans and policies and can certify all policies and plans are in compliance with the Federal Parity law and its implementing regulations and interim rules.

HB117 amends 40 Pa. C.S. by adding a new chapter 39. §3903 requires all insurers, including any entity that issues or administers health insurance policies or health plans, and are subject to the jurisdiction of the Insurance Department, to annually submit information to the Insurance Department information data regarding denials and use of managed care techniques surrounding substance use disorder claims, including the number of insureds and plan members receiving covered addiction treatment and a breakdown of addiction treatment covered by the plan. §3904 requires the Insurance Department to compile the information submitted by insurers into a report, provide the report to the Department of Drug and Alcohol Programs, and make such report available on a publicly accessible website. §3905 requires the Department of Drug and Alcohol Programs to review the above report to determine compliance with federal parity requirements. Findings should be compiled into an additional report and sent to the Public Health and Welfare Committee of the Senate, the Human Service Committee of the House of Representatives, and be made available on a publicly accessible website.

HB440 amends 40 Pa. C. L. by adding a part V. §8114 and §8115 require any health insurance policy subject to the jurisdiction of the Insurance Department and any group health, sickness, or accident policy, subscriber contract, or certificate to offer coverage for mental illness, alcohol, and other drug abuse and dependency for at least 30 inpatient and 60 outpatient days annually and mandate parity in dollar limits, cost-sharing arrangements, and the imposition of NQTLs on such benefits. §8114 and §8115 require the Legislative Budget and Finance Committee to complete a cost and benefit report regarding the above, focusing on topics including the effect of this act on policy premiums, enforcement activities, service use, etc. §8123, §8124, and §8126 require all group health, sickness, or accident insurance policies and all group subscriber contracts or certificates that provide hospital or medical/surgical coverage to include specified coverage for inpatient detoxification services, alcohol and other drug non-hospital residential services, and alcohol and other drug outpatient services. §8134 requires insurers (defined as a foreign or domestic insurance company, association or exchange, health maintenance organization, hospital plan corporation, professional health services plan corporation, fraternal benefit society or risk-assuming preferred provider organization) to submit annual comparative reports to demonstrate compliance with parity requirements. Such reports must include data regarding the preceding year’s rates of prior authorization, use of NQTLs on mental health and substance use disorder benefits, and a signed certification by the insurer’s CEO and CMO. §8135 sets penalties the commissioner may pursue if an insurer is in violation of this act. Penalties include civil monetary penalties, entering a cease and desist order, and suspension, revocation, or refusal to renew the license of the offending entity. §8136 requires the Insurance Department to implement and enforce the Federal Parity Law and its implementing regulations by ensuring compliance, detecting violations, accepting and evaluating complaints, conducting market conduct examinations, etc. Such activities, including any educational or corrective actions taken by the Department to ensure compliance, must be reported and presented to the General Assembly. This report must be written in nontechnical language and made available to the public by posting on the Department’s publicly available website.

Among other provisions, Section 6 amends 71 Pa C.L. §2334 and §2803-F to require the Insurance Department to submit to the Department of Drug and Alcohol Programs a report including the number of complaints regarding parity, the efforts taken to ensure compliance with parity requirements, and how beneficiaries are made aware of mental health and substance use disorder benefits in their current plans and when choosing a plan. §2805-F is amended to require the Attorney General to provide a report to the General Assembly that includes information regarding complaints made in relation to parity requirements.

HB1997 amends 60 Pa C.L. by adding §449.1 to establish a deemed eligibility program to provide medical assistance payments for inpatient behavioral health services. Eligible individuals include those with an immediate need for inpatient services for a behavioral health problem as result of a health crisis based upon prior hospitalizations, those experiencing danger presenting to the individual’s physical or mental health, etc. Within 60 days of submitting an application for medical assistance, the department must make a final decision on eligibility. If approved, medical assistance payments for inpatient behavioral health services shall be authorized during the period of presumed eligibility beginning the date the individual was deemed eligible.

HB 2472 amends 71 Pa C.L. by repealing parts of §2334 and replacing with language that requires the Department of Human Services, for purposes of medical assistance payments for alcohol and drug detoxification and rehabilitation services, to include, as an access standard in agreements with managed care organizations, provider networks for ambulatory services must include at least two providers within a set geographical range. If certain criteria are met, a third substance use provider must be provided as well.

SB 244 amends 40 Pa. C.S.A to add a section 635.8 to mandate insurers, including any group health, sickness, or accident policies, subscriber contracts, or certificates offered to groups of fifty-one or more employees, to provide equitable, nondiscriminatory coverage for treatment of eating disorders, including residential treatment, if the treatment is deemed medically necessary in accordance with relating American Psychiatric Association guidelines.

HB 116 amends 40 Pa. C.L. §3903 to require the Insurance Department direct all insurers, including any entity that issues or administers health insurance policies or health plans and is subject to the jurisdiction of the Insurance Department, to provide members and insureds with a 1-2 page emergency addendum that clearly and understandably explains plan and policy coverage of addiction treatment services and how to file an appeal. Addendums must be submitted to the Department of Drug and Alcohol Programs to review for clarity and accuracy and approval.

In addition to consolidating certain behavioral health insurance coverage sections into on section, this bill tries to change the sections of state law relevant to parity in many ways. This bill will do the following:

• Defines behavioral health conditions as they are defined in the most recent versions of the ICD or DSM
• Defines non-quantitative treatment limitations (NQTLs) as they are defined in the Federal Parity Law and lists many examples
• Prohibits large employer fully-insured plans from applying NQTLs to behavioral health services more restrictively than they are applied to other medical services
• Requires small employer fully-insured plans and large employer fully-insured plans to use the criteria of the American Society of Addiction Medicine when performing utilization review of substance use disorder services
• Requires small employer fully-insured plans and large employer fully-insured plans to cover any FDA-approved medications for treatment of substance use disorders
• Requires all insurance plans subject to state jurisdiction to submit annual reports that demonstrate their compliance with the Federal Parity Law, including information that shows that NQTLs for behavioral health services are applied no more restrictively than those used for other medical services
• Provides detailed instructions for how the Insurance Department can implement the Federal Parity Law and relevant sections of state law
• Requires the Insurance Department to submit annual reports showing how they are implementing the Federal Parity Law and relevant sections of state law

This bill tried to change the sections of state law relevant to parity in many ways. This bill will do the following:

• Defines behavioral health conditions as they are defined in the most recent versions of the ICD or DSM
• Defines non-quantitative treatment limitations (NQTLs) as they are defined in the Federal Parity Law and lists many examples
• Prohibits large employer fully-insured plans from applying NQTLs to behavioral health services more restrictively than they are applied to other medical services
• Specifies that the “Drugs, medicines, equipment use and supplies” that small employer fully insured plans and large employer fully-insured plans are already required to cover for substance use disorder treatment includes opioid antagonists(Naloxone)
• Requires small employer fully-insured plans and large employer fully-insured plans to use the criteria of the American Society of Addiction Medicine when performing utilization review of substance use disorder services
• Requires small employer fully-insured plans and large employer fully-insured plans to cover any FDA-approved medications for treatment of substance use disorders
• Requires all insurance plans subject to state jurisdiction to submit annual reports that demonstrate their compliance with the Federal Parity Law, including information that shows that NQTLs for behavioral health services are applied no more restrictively than those used for other medical services
• Provides detailed instructions for how the Insurance Department can implement the Federal Parity Law and relevant sections of state law
• Requires the Insurance Department to submit annual reports showing how they are implementing the Federal Parity Law and relevant sections of state law

This bill tries to add a section of the state insurance law on mental health parity and substance use disorder treatment. The bill will do the following:

• Requires health insurers submit annually the following information: number of plan members, number of plan members receiving addiction treatment, and the types of addiction treatment covered by the plan
• Requires the Pennsylvania Insurance Department collect the information submitted above by insurers and disseminate the information publicly
• Requires the Pennsylvania Insurance Department and the Department of Drug and Alcohol Programs to review this report for compliance with the Federal Parity Law and the parity section of state law
• Requires the Pennsylvania Department of Insurance to release regulations that are necessary to actualize the requirements in this bill
• Requires health insurers to pay for any expenses carried out in the collection and review of submitted materials

This bill tries to add a section of the state insurance law on mental health and substance use disorder treatment. It requires that health insures that do not manage the mental health and substance use disorder benefits within the plans they issue must complete a comprehensive review of these benefits for compliance with the Federal Parity Law and the state parity law.

This bill amends the state insurance law by extending the definition of autism service provider to include an individual who meets the following requirements:

• Enrolled in or has completed a master’s or higher degree program
• Has completed at least one thousand hours in direct clinical experience with individuals with behavioral challenges or at least 1,000 hours experience in a related field with individuals with autism
• Provides the treatment under the supervision of a licensed behavioral health specialist

It also sets out the requirements for a temporary license for individuals who meet the requirements of an autism service provider except the experience and training requirements. These licenses may be issued to an individual who completes a master’s or higher degree from a board approved college with a major in counseling psychology, special education, social work, speech therapy, occupational therapy, or related field.

This bill adds a section to the state insurance law by requiring health insurers to cover assertive community treatment for individuals age 18 or older with serious and persistent mental illness and meets two of the following requirements:

• At least two psychiatric hospitalizations in the past twelve months or lengths of stay totaling thirty days in the past twelve month
• Intractable severe major symptoms
• Co-occurring mental illness and substance use disorders lasting more than six months
• High risk or recent history of criminal justice involvement
• Homeless, at imminent risk of being homeless, or residing in unsafe housing
• Resides in an inpatient or supervised community residence but clinically assessed to be capable of living in a more independent living situation if intensive services are provided or requires residential or institutional placement

This bill amends the state insurance law by extending the definition of autism service provider to include an individual holding a valid temporary graduate behavior specialist license. The bill defines a temporary graduate behavior specialist as an individual who meets all of the qualifications of a behavior specialist except the experience and training requirements.

This bill amends the state insurance law by adding a section clarifying that an individual diagnosed with autism using the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV criteria will be continue to have a diagnosis of autism regardless of whether the DSM V makes any changes to the diagnostic criteria for autism.

This bill tried to amend the parity provisions within state law to require insurance plans to pay for assisted outpatient treatment (AOT.) The bill also listed the specific AOT services that must be covered by insurance plans.

This bill tried to amend the parity provisions within state law so that a person who was diagnosed with autism spectrum disorder according to the standards of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV) would still be deemed to have autism spectrum disorder even if the DSM V made changes to the diagnostic criteria for having autism spectrum disorder.

This bill tried to amend the parity provisions within state law so that a person who was diagnosed with autism spectrum disorder according to the standards of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV) would still be deemed to have autism spectrum disorder even if the DSM V made changes to the diagnostic criteria for having autism spectrum disorder.

This bill was rolled into SB 237 listed above, which was signed into law. The section in SB 237 pertaining to parity is identical to this bill. This bill was the Senate version. The House version is listed below.

This bill was rolled into SB 237 listed above, which was signed into law. The section in SB 237 pertaining to parity is identical to this bill. This bill was the House version. The Senate version is listed above.