Indiana 2022 Regular Session

Indiana House Bill HB1018 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2	Introduced Version
3	3	HOUSE BILL No. 1018
4	4	_____
5	5	DIGEST OF INTRODUCED BILL
6	6	Citations Affected: IC 5-10-8-9; IC 12-15; IC 12-21-9; IC 12-23-18;
7	7	IC 16-21-8.5; IC 27-8-5-15.8; IC 27-13-7-14.2.
8	8	Synopsis: Mental health and addiction matters. Specifies that an
9	9	individual's incarceration, hospitalization, or other temporary cessation
10	10	in substance or chemical use may not be used as a factor in determining
11	11	the individual's eligibility for coverage in: (1) a state employee health
12	12	care plan; (2) Medicaid; (3) the healthy Indiana plan; (4) a policy of
13	13	accident and sickness insurance; or (5) a health maintenance health
14	14	care contract. Requires an opioid treatment program to: (1) provide a
15	15	patient of the facility appropriate referrals for continuing care before
16	16	releasing the patient from care by the facility; and (2) counsel female
17	17	patients concerning the effects of the program treatment if the female
18	18	is or becomes pregnant and provide to the patient birth control if
19	19	requested by the patient. Requires the division of mental health and
20	20	addiction (division) to annually perform an audit of 20% of an opioid
21	21	treatment program facility's patient plans to ensure compliance with
22	22	federal and state laws and regulations. Requires the division to
23	23	establish a mental health and addiction program to reduce the stigma
24	24	of mental illness and addiction. Requires hospitals to establish
25	25	emergency room treatment protocols concerning treatment of a patient
26	26	who is overdosing, has been provided an overdose intervention drug,
27	27	or is otherwise identified as having a substance use disorder.
28	28	Effective: July 1, 2022.
29	29	Shackleford
30	30	January 4, 2022, read first time and referred to Committee on Public Health.
31	31	2022 IN 1018—LS 6278/DI 104 Introduced
32	32	Second Regular Session of the 122nd General Assembly (2022)
33	33	PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
34	34	Constitution) is being amended, the text of the existing provision will appear in this style type,
35	35	additions will appear in this style type, and deletions will appear in this style type.
36	36	Additions: Whenever a new statutory provision is being enacted (or a new constitutional
37	37	provision adopted), the text of the new provision will appear in this style type. Also, the
38	38	word NEW will appear in that style type in the introductory clause of each SECTION that adds
39	39	a new provision to the Indiana Code or the Indiana Constitution.
40	40	Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
41	41	between statutes enacted by the 2021 Regular Session of the General Assembly.
42	42	HOUSE BILL No. 1018
43	43	A BILL FOR AN ACT to amend the Indiana Code concerning
44	44	human services.
45	45	Be it enacted by the General Assembly of the State of Indiana:
46	46	1 SECTION 1. IC 5-10-8-9 IS AMENDED TO READ AS FOLLOWS
47	47	2 [EFFECTIVE JULY 1, 2022]: Sec. 9. (a) This section does not apply
48	48	3 if the application of this section would increase the premiums of the
49	49	4 health services policy or plan, as certified under IC 27-8-5-15.7, by
50	50	5 more than four percent (4%) as a result of complying with subsection
51	51	6 (c).
52	52	7 (b) As used in this section, "coverage of services for mental illness"
53	53	8 includes benefits with respect to mental health services as defined by
54	54	9 the contract, policy, or plan for health services. The term includes
55	55	10 services for the treatment of substance abuse and chemical dependency
56	56	11 when the services are required in the treatment of a mental illness.
57	57	12 (c) If the state enters into a contract for health services through
58	58	13 prepaid health care delivery plans, medical self-insurance, or group
59	59	14 health insurance for state employees, the contract may not permit
60	60	15 treatment limitations or financial requirements on the coverage of
61	61	16 services for mental illness if similar limitations or requirements are not
62	62	17 imposed on the coverage of services for other medical or surgical
63	63	2022 IN 1018—LS 6278/DI 104 2
64	64	1 conditions.
65	65	2 (d) This section subsection applies to a contract for health services
66	66	3 through prepaid health care delivery plans, medical self-insurance, or
67	67	4 group medical coverage for state employees that is issued, entered into,
68	68	5 or renewed after June 30, 1997. June 30, 2022. If the state enters into
69	69	6 a contract for health services through prepaid health care delivery
70	70	7 plans, medical self-insurance, or group health insurance for state
71	71	8 employees, the contract may not allow an individual's
72	72	9 incarceration, hospitalization, or other temporary cessation in
73	73	10 substance or chemical use to factor into a determination of an
74	74	11 individual's eligibility for coverage of the treatment of substance
75	75	12 abuse or chemical dependency.
76	76	13 (e) This section does not require the contract for health services to
77	77	14 offer mental health benefits.
78	78	15 SECTION 2. IC 12-15-5-13, AS AMENDED BY P.L.179-2019,
79	79	16 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
80	80	17 JULY 1, 2022]: Sec. 13. (a) The office shall provide coverage for
81	81	18 treatment of opioid or alcohol dependence that includes the following:
82	82	19 (1) Counseling services that address the psychological and
83	83	20 behavioral aspects of addiction.
84	84	21 (2) When medically indicated, drug treatment involving agents
85	85	22 approved by the federal Food and Drug Administration for the:
86	86	23 (A) treatment of opioid or alcohol dependence; or
87	87	24 (B) prevention of relapse to opioids or alcohol after
88	88	25 detoxification.
89	89	26 (3) When determined by the treatment plan to be medically
90	90	27 necessary, inpatient detoxification in accordance with the most
91	91	28 current edition of the American Society of Addiction Medicine
92	92	29 Patient Placement Criteria.
93	93	30 In determining eligibility for substance abuse treatment for a
94	94	31 recipient, the office or a managed care organization may not
95	95	32 consider an individual's incarceration, hospitalization, or other
96	96	33 temporary cessation in substance or chemical use as a factor to
97	97	34 deny eligibility.
98	98	35 (b) The office shall:
99	99	36 (1) develop quality measures to ensure; and
100	100	37 (2) require a managed care organization to report;
101	101	38 compliance with the coverage required under subsection (a).
102	102	39 (c) The office may implement quality capitation withholding of
103	103	40 reimbursement to ensure that a managed care organization has
104	104	41 provided the coverage required under subsection (a).
105	105	42 (d) The office shall report the clinical use of the medications
106	106	2022 IN 1018—LS 6278/DI 104 3
107	107	1 covered under this section to the mental health Medicaid quality
108	108	2 advisory committee established by IC 12-15-35-51. The mental health
109	109	3 Medicaid quality advisory committee may make recommendations to
110	110	4 the office concerning this section.
111	111	5 SECTION 3. IC 12-15-44.5-3.5, AS ADDED BY P.L.30-2016,
112	112	6 SECTION 28, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
113	113	7 JULY 1, 2022]: Sec. 3.5. (a) The plan must include the following in a
114	114	8 manner and to the extent determined by the office:
115	115	9 (1) Mental health care services.
116	116	10 (2) Inpatient hospital services.
117	117	11 (3) Prescription drug coverage, including coverage of a long
118	118	12 acting, nonaddictive medication assistance treatment drug if the
119	119	13 drug is being prescribed for the treatment of substance abuse.
120	120	14 (4) Emergency room services.
121	121	15 (5) Physician office services.
122	122	16 (6) Diagnostic services.
123	123	17 (7) Outpatient services, including therapy services.
124	124	18 (8) Comprehensive disease management.
125	125	19 (9) Home health services, including case management.
126	126	20 (10) Urgent care center services.
127	127	21 (11) Preventative care services.
128	128	22 (12) Family planning services:
129	129	23 (A) including contraceptives and sexually transmitted disease
130	130	24 testing, as described in federal Medicaid law (42 U.S.C. 1396
131	131	25 et seq.); and
132	132	26 (B) not including abortion or abortifacients.
133	133	27 (13) Hospice services.
134	134	28 (14) Substance abuse services.
135	135	29 (15) Pregnancy services.
136	136	30 (16) A service determined by the secretary to be required by
137	137	31 federal law as a benchmark service under the federal Patient
138	138	32 Protection and Affordable Care Act.
139	139	33 (b) The plan may not permit the following:
140	140	34 (1) Treatment limitations or financial requirements on the
141	141	35 coverage of mental health care services or substance abuse
142	142	36 services if similar limitations or requirements are not imposed on
143	143	37 the coverage of services for other medical or surgical conditions.
144	144	38 (2) In determining coverage for substance abuse treatment,
145	145	39 the plan may not factor in an individual's incarceration,
146	146	40 hospitalization, or other temporary cessation in substance or
147	147	41 chemical use when determining the individual's eligibility for
148	148	42 the treatment.
149	149	2022 IN 1018—LS 6278/DI 104 4
150	150	1 (c) The plan may provide vision services and dental services only
151	151	2 to individuals who regularly make the required monthly contributions
152	152	3 for the plan as set forth in section 4.7(c) of this chapter.
153	153	4 (d) The benefit package offered in the plan:
154	154	5 (1) must be benchmarked to a commercial health plan described
155	155	6 in 45 CFR 155.100(a)(1) or 45 CFR 155.100(a)(4); and
156	156	7 (2) may not include a benefit that is not present in at least one (1)
157	157	8 of these commercial benchmark options.
158	158	9 (e) The office shall provide to an individual who participates in the
159	159	10 plan a list of health care services that qualify as preventative care
160	160	11 services for the age, gender, and preexisting conditions of the
161	161	12 individual. The office shall consult with the federal Centers for Disease
162	162	13 Control and Prevention for a list of recommended preventative care
163	163	14 services.
164	164	15 (f) The plan shall, at no cost to the individual, provide payment of
165	165	16 preventative care services described in 42 U.S.C. 300gg-13 for an
166	166	17 individual who participates in the plan.
167	167	18 (g) The plan shall, at no cost to the individual, provide payments of
168	168	19 not more than five hundred dollars ($500) per year for preventative
169	169	20 care services not described in subsection (f). Any additional
170	170	21 preventative care services covered under the plan and received by the
171	171	22 individual during the year are subject to the deductible and payment
172	172	23 requirements of the plan.
173	173	24 SECTION 4. IC 12-21-9 IS ADDED TO THE INDIANA CODE AS
174	174	25 A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY
175	175	26 1, 2022]:
176	176	27 Chapter 9. Mental Health Education Program
177	177	28 Sec. 1. The division shall establish and administer a statewide
178	178	29 program to reduce the stigma of mental illness and addiction in
179	179	30 Indiana.
180	180	31 Sec. 2. The program must include the following:
181	181	32 (1) Awareness raising interventions, including signs or
182	182	33 symptoms that an individual may be suffering from a mental
183	183	34 illness or addiction.
184	184	35 (2) Literacy programs to improve knowledge of mental
185	185	36 illnesses and addiction.
186	186	37 (3) Dissemination of lists of resources available on a regional
187	187	38 basis to individuals who believe they are suffering from a
188	188	39 mental illness or addiction.
189	189	40 (4) The benefits of obtaining services to treat a mental illness
190	190	41 or addiction.
191	191	42 (5) Dissemination of educational materials targeted to
192	192	2022 IN 1018—LS 6278/DI 104 5
193	193	1 different ages and populations.
194	194	2 SECTION 5. IC 12-23-18-0.5, AS AMENDED BY P.L.8-2016,
195	195	3 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
196	196	4 JULY 1, 2022]: Sec. 0.5. (a) An opioid treatment program shall not
197	197	5 operate in Indiana unless the opioid treatment program meets the
198	198	6 following conditions:
199	199	7 (1) Is specifically approved and the opioid treatment facility is
200	200	8 certified by the division.
201	201	9 (2) Is in compliance with state and federal law.
202	202	10 (3) Provides treatment for opioid addiction using a drug approved
203	203	11 by the federal Food and Drug Administration for the treatment of
204	204	12 opioid addiction, including:
205	205	13 (A) opioid maintenance;
206	206	14 (B) detoxification;
207	207	15 (C) overdose reversal;
208	208	16 (D) relapse prevention; and
209	209	17 (E) long acting, nonaddictive medication assisted treatment
210	210	18 medications.
211	211	19 (4) Beginning July 1, 2017, is:
212	212	20 (A) enrolled:
213	213	21 (i) as a Medicaid provider under IC 12-15; and
214	214	22 (ii) as a healthy Indiana plan provider under IC 12-15-44.2;
215	215	23 or
216	216	24 (B) enrolled as an ordering, prescribing, or referring provider
217	217	25 in accordance with Section 6401 of the federal Patient
218	218	26 Protection and Affordable Care Act (P.L. 111-148), as
219	219	27 amended by the federal Health Care and Education
220	220	28 Reconciliation Act of 2010 (P.L. 111-152) and maintains a
221	221	29 memorandum of understanding with a community mental
222	222	30 health center for the purpose of ordering, prescribing, or
223	223	31 referring treatments covered by Medicaid and the healthy
224	224	32 Indiana plan.
225	225	33 (5) Provides to a patient of the opioid treatment facility who
226	226	34 is being released from the program referrals to appropriate
227	227	35 providers to continue the care that:
228	228	36 (A) the facility deems appropriate for the patient; or
229	229	37 (B) the patient requests;
230	230	38 before the patient's release from care of the facility.
231	231	39 (b) Separate specific approval and certification under this chapter
232	232	40 is required for each location at which an opioid treatment program is
233	233	41 operated. If an opioid treatment program moves the opioid treatment
234	234	42 program's facility to another location, the opioid treatment program's
235	235	2022 IN 1018—LS 6278/DI 104 6
236	236	1 certification does not apply to the new location and certification for the
237	237	2 new location under this chapter is required.
238	238	3 (c) Each opioid treatment program that is enrolled as an ordering,
239	239	4 prescribing, or referring provider shall report to the office on an annual
240	240	5 basis the services provided to Indiana Medicaid patients. The report
241	241	6 must include the following:
242	242	7 (1) The number of Medicaid patients seen by the ordering,
243	243	8 prescribing, or referring provider.
244	244	9 (2) The services received by the provider's Medicaid patients,
245	245	10 including any drugs prescribed.
246	246	11 (3) The number of Medicaid patients referred to other providers.
247	247	12 (4) Any other provider types to which the Medicaid patients were
248	248	13 referred.
249	249	14 SECTION 6. IC 12-23-18-5, AS AMENDED BY P.L.181-2021,
250	250	15 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
251	251	16 JULY 1, 2022]: Sec. 5. (a) The division shall adopt rules under
252	252	17 IC 4-22-2 to establish the following:
253	253	18 (1) Standards for operation of an opioid treatment program in
254	254	19 Indiana, including the following requirements:
255	255	20 (A) Except as otherwise prescribed by the division, an opioid
256	256	21 treatment program shall obtain prior authorization from the
257	257	22 division for any patient receiving more than fourteen (14) days
258	258	23 of opioid maintenance treatment medications at one (1) time
259	259	24 and the division may approve the authorization only under the
260	260	25 following circumstances:
261	261	26 (i) A physician licensed under IC 25-22.5 has issued an
262	262	27 order for the opioid treatment medication.
263	263	28 (ii) The patient has not tested positive under a drug test for
264	264	29 a drug for which the patient does not have a prescription for
265	265	30 a period of time set forth by the division.
266	266	31 (iii) The opioid treatment program has determined that the
267	267	32 benefit to the patient in receiving the take home opioid
268	268	33 treatment medication outweighs the potential risk of
269	269	34 diversion of the take home opioid treatment medication.
270	270	35 (B) Minimum requirements for a licensed physician's regular:
271	271	36 (i) physical presence in the opioid treatment facility; and
272	272	37 (ii) physical evaluation and progress evaluation of each
273	273	38 opioid treatment program patient.
274	274	39 (C) Minimum staffing requirements by licensed and
275	275	40 unlicensed personnel.
276	276	41 (D) Clinical standards for the appropriate tapering of a patient
277	277	42 on and off of an opioid treatment medication.
278	278	2022 IN 1018—LS 6278/DI 104 7
279	279	1 (E) The provision of counseling to female patients upon
280	280	2 admission and periodically through the patient's treatment
281	281	3 by the facility concerning the effects of the program
282	282	4 treatment if the female is or becomes pregnant, and the
283	283	5 provision to the patient of birth control if requested by the
284	284	6 patient.
285	285	7 (2) A requirement that, not later than February 28 of each year, a
286	286	8 current diversion control plan that meets the requirements of 21
287	287	9 CFR Part 290 and 42 CFR Part 8 be submitted for each opioid
288	288	10 treatment facility.
289	289	11 (3) Fees to be paid by an opioid treatment program for deposit in
290	290	12 the fund for annual certification under this chapter as described
291	291	13 in section 3 of this chapter.
292	292	14 The fees established under this subsection must be sufficient to pay the
293	293	15 cost of implementing this chapter.
294	294	16 (b) The division shall conduct an annual onsite visit of each opioid
295	295	17 treatment program facility to assess compliance with this chapter. As
296	296	18 part of an annual onsite visit, the division shall audit at least twenty
297	297	19 percent (20%) of the opioid treatment program facility's patient
298	298	20 plans to determine whether the facility is complying with federal
299	299	21 and state rules and regulations, including the following:
300	300	22 (1) Meeting tapering standards established by the division
301	301	23 under subsection (a)(1)(D).
302	302	24 (2) Complying with the goal of providing a patient with the
303	303	25 minimal clinically necessary medication dose, with the goal of
304	304	26 opioid abstinence as set forth in section 5.3 of this chapter.
305	305	27 (3) Performing and complying with the drug testing
306	306	28 requirements for patients set forth in section 2.5 of this
307	307	29 chapter.
308	308	30 (4) Racial demographics of the patients.
309	309	31 Any personally identifying information and medical information
310	310	32 of a patient obtained through the audit are confidential.
311	311	33 (c) Not later than April 1 of each year, the division shall report to
312	312	34 the general assembly in electronic format under IC 5-14-6 the
313	313	35 following information:
314	314	36 (1) The number of prior authorizations that were approved under
315	315	37 subsection (a)(1)(A) in the previous year and the:
316	316	38 (A) time frame for each approval; and
317	317	39 (B) duration of each approved treatment.
318	318	40 (2) The number of authorizations under subdivision (1) that were,
319	319	41 in the previous year, revoked due to a patient's violation of an
320	320	42 applicable term or condition.
321	321	2022 IN 1018—LS 6278/DI 104 8
322	322	1 (3) The number of each of the actions taken under section 5.8(a)
323	323	2 of this chapter in the previous year.
324	324	3 (4) The number and type of violations assessed for each action
325	325	4 specified in section 5.8(a) of this chapter in the previous year.
326	326	5 (d) A facility shall report, in a manner prescribed by the division, all
327	327	6 information required by the division to complete the report described
328	328	7 in subsection (c).
329	329	8 SECTION 7. IC 16-21-8.5 IS ADDED TO THE INDIANA CODE
330	330	9 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
331	331	10 JULY 1, 2022]:
332	332	11 Chapter 8.5. Emergency Room Treatment of Patients With
333	333	12 Substance Use Disorders
334	334	13 Sec. 1. Not later than January 1, 2023, a hospital licensed under
335	335	14 this article shall have established protocols on the emergency room
336	336	15 treatment of a patient who:
337	337	16 (1) is overdosing on a substance;
338	338	17 (2) has been provided an overdose intervention drug
339	339	18 immediately prior to being transported to the hospital; or
340	340	19 (3) is otherwise identified as having a substance use disorder.
341	341	20 Sec. 2. The protocols required in section 1 of this chapter must
342	342	21 include the following:
343	343	22 (1) An assessment of the patient before discharge by a
344	344	23 provider whose scope of practice includes providing
345	345	24 treatment for an individual with a substance use disorder,
346	346	25 including:
347	347	26 (A) a physician licensed under IC 25-22.5;
348	348	27 (B) a psychologist licensed under IC 25-33;
349	349	28 (C) an addiction counselor or a clinical addiction counselor
350	350	29 licensed under IC 25-23.6-10.5; or
351	351	30 (D) a person described in IC 25-23.6-10.1-2.
352	352	31 (2) Treatment, assistance in obtaining treatment, or a referral
353	353	32 to treatment to a provider described in subdivision (1).
354	354	33 Sec. 3. The hospital shall provide training on the protocols to
355	355	34 any staff or contractor providing services in the emergency
356	356	35 department of the hospital.
357	357	36 SECTION 8. IC 27-8-5-15.8, AS ADDED BY P.L.103-2020,
358	358	37 SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
359	359	38 JULY 1, 2022]: Sec. 15.8. (a) As used in this section, "treatment of a
360	360	39 mental illness or substance abuse" means:
361	361	40 (1) treatment for a mental illness, as defined in IC 12-7-2-130(1);
362	362	41 and
363	363	42 (2) treatment for drug abuse or alcohol abuse.
364	364	2022 IN 1018—LS 6278/DI 104 9
365	365	1 (b) As used in this section, "act" refers to the Paul Wellstone and
366	366	2 Pete Domenici Mental Health Parity and Addiction Act of 2008 and
367	367	3 any amendments thereto, plus any federal guidance or regulations
368	368	4 relevant to that act, including 45 CFR 146.136, 45 CFR 147.136, 45
369	369	5 CFR 147.160, and 45 CFR 156.115(a)(3).
370	370	6 (c) As used in this section, "nonquantitative treatment limitations"
371	371	7 refers to those limitations described in 26 CFR 54.9812-1, 29 CFR
372	372	8 2590.712, and 45 CFR 146.136.
373	373	9 (d) An insurer that issues a policy of accident and sickness
374	374	10 insurance that provides coverage of services for treatment of a mental
375	375	11 illness or substance abuse shall submit a report to the department not
376	376	12 later than December 31 of each year that contains the following
377	377	13 information:
378	378	14 (1) A description of the processes:
379	379	15 (A) used to develop or select the medical necessity criteria for
380	380	16 coverage of services for treatment of a mental illness or
381	381	17 substance abuse; and
382	382	18 (B) used to develop or select the medical necessity criteria for
383	383	19 coverage of services for treatment of other medical or surgical
384	384	20 conditions.
385	385	21 (2) Identification of all nonquantitative treatment limitations that
386	386	22 are applied to:
387	387	23 (A) coverage of services for treatment of a mental illness or
388	388	24 substance abuse; and
389	389	25 (B) coverage of services for treatment of other medical or
390	390	26 surgical conditions;
391	391	27 within each classification of benefits.
392	392	28 (e) Coverage of treatment of a mental illness or substance abuse
393	393	29 must meet the following:
394	394	30 (1) There may be no separate nonquantitative treatment
395	395	31 limitations that apply to coverage of services for treatment of a
396	396	32 mental illness or substance abuse that do not apply to coverage of
397	397	33 services for treatment of other medical or surgical conditions
398	398	34 within any classification of benefits.
399	399	35 (2) An individual's incarceration, hospitalization, or other
400	400	36 temporary cessation in substance or chemical use may not
401	401	37 factor into a determination of the individual's eligibility for
402	402	38 coverage of the treatment of mental illness or substance
403	403	39 abuse.
404	404	40 (f) An insurer that issues a policy of accident and sickness insurance
405	405	41 that provides coverage of services for treatment of a mental illness or
406	406	42 substance abuse shall also submit an analysis showing the insurer's
407	407	2022 IN 1018—LS 6278/DI 104 10
408	408	1 compliance with this section and the act to the department not later
409	409	2 than December 31 of each year. The analysis must do the following:
410	410	3 (1) Identify the factors used to determine that a nonquantitative
411	411	4 treatment limitation will apply to a benefit, including factors that
412	412	5 were considered but rejected.
413	413	6 (2) Identify and define the specific evidentiary standards used to
414	414	7 define the factors and any other evidence relied upon in designing
415	415	8 each nonquantitative treatment limitation.
416	416	9 (3) Provide the comparative analyses, including the results of the
417	417	10 analyses, performed to determine the following:
418	418	11 (A) That the processes and strategies used to design each
419	419	12 nonquantitative treatment limitation for coverage of services
420	420	13 for treatment of a mental illness or substance abuse are
421	421	14 comparable to, and applied no more stringently than, the
422	422	15 processes and strategies used to design each nonquantitative
423	423	16 treatment limitation for coverage of services for treatment of
424	424	17 other medical or surgical conditions.
425	425	18 (B) That the processes and strategies used to apply each
426	426	19 nonquantitative treatment limitation for treatment of a mental
427	427	20 illness or substance abuse are comparable to, and applied no
428	428	21 more stringently than, the processes and strategies used to
429	429	22 apply each nonquantitative limitation for treatment of other
430	430	23 medical or surgical conditions.
431	431	24 (g) The department shall adopt rules to ensure compliance with this
432	432	25 section and the applicable provisions of the act.
433	433	26 SECTION 9. IC 27-13-7-14.2, AS ADDED BY P.L.103-2020,
434	434	27 SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
435	435	28 JULY 1, 2022]: Sec. 14.2. (a) As used in this section, "treatment of a
436	436	29 mental illness or substance abuse" means:
437	437	30 (1) treatment for a mental illness, as defined in IC 12-7-2-130(1);
438	438	31 and
439	439	32 (2) treatment for drug abuse or alcohol abuse.
440	440	33 (b) As used in this section, "act" refers to the Paul Wellstone and
441	441	34 Pete Domenici Mental Health Parity and Addiction Act of 2008 and
442	442	35 any amendments thereto, plus any federal guidance or regulations
443	443	36 relevant to that act, including 45 CFR 146.136, 45 CFR 147.136, 45
444	444	37 CFR 147.160, and 45 CFR 156.115(a)(3).
445	445	38 (c) As used in this section, "nonquantitative treatment limitations"
446	446	39 refers to those limitations described in 26 CFR 54.9812-1, 29 CFR
447	447	40 2590.712, and 45 CFR 146.136.
448	448	41 (d) An individual contract or a group contract that provides
449	449	42 coverage of services for treatment of a mental illness or substance
450	450	2022 IN 1018—LS 6278/DI 104 11
451	451	1 abuse shall submit a report to the department not later than December
452	452	2 31 of each year that contains the following information:
453	453	3 (1) A description of the processes:
454	454	4 (A) used to develop or select the medical necessity criteria for
455	455	5 coverage of services for treatment of a mental illness or
456	456	6 substance abuse; and
457	457	7 (B) used to develop or select the medical necessity criteria for
458	458	8 coverage of services for treatment of other medical or surgical
459	459	9 conditions.
460	460	10 (2) Identification of all nonquantitative treatment limitations that
461	461	11 are applied to:
462	462	12 (A) coverage of services for treatment of a mental illness or
463	463	13 substance abuse; and
464	464	14 (B) coverage of services for treatment of other medical or
465	465	15 surgical conditions;
466	466	16 within each classification of benefits.
467	467	17 (e) Coverage of treatment of a mental illness or substance abuse
468	468	18 must meet the following:
469	469	19 (1) There may be no separate nonquantitative treatment
470	470	20 limitations that apply to coverage of services for treatment of a
471	471	21 mental illness or substance abuse that do not apply to coverage of
472	472	22 services for treatment of other medical or surgical conditions
473	473	23 within any classification of benefits.
474	474	24 (2) An individual's incarceration, hospitalization, or other
475	475	25 temporary cessation in substance or chemical use may not
476	476	26 factor into a determination of the individual's eligibility for
477	477	27 coverage of the treatment of mental illness or substance
478	478	28 abuse.
479	479	29 (f) An individual contract or a group contract that provides coverage
480	480	30 of services for treatment of a mental illness or substance abuse shall
481	481	31 also submit an analysis showing the insurer's compliance with this
482	482	32 section and the act to the department not later than December 31 of
483	483	33 each year. The analysis must do the following:
484	484	34 (1) Identify the factors used to determine that a nonquantitative
485	485	35 treatment limitation will apply to a benefit, including factors that
486	486	36 were considered but rejected.
487	487	37 (2) Identify and define the specific evidentiary standards used to
488	488	38 define the factors and any other evidence relied upon in designing
489	489	39 each nonquantitative treatment limitation.
490	490	40 (3) Provide the comparative analyses, including the results of the
491	491	41 analyses, performed to determine the following:
492	492	42 (A) That the processes and strategies used to design each
493	493	2022 IN 1018—LS 6278/DI 104 12
494	494	1 nonquantitative treatment limitation for coverage of services
495	495	2 for treatment of a mental illness or substance abuse are
496	496	3 comparable to, and applied no more stringently than, the
497	497	4 processes and strategies used to design each nonquantitative
498	498	5 treatment limitation for coverage of services for treatment of
499	499	6 other medical or surgical conditions.
500	500	7 (B) That the processes and strategies used to apply each
501	501	8 nonquantitative treatment limitation for treatment of a mental
502	502	9 illness or substance abuse are comparable to, and applied no
503	503	10 more stringently than, the processes and strategies used to
504	504	11 apply each nonquantitative limitation for treatment of other
505	505	12 medical or surgical conditions.
506	506	13 (g) The department shall adopt rules to ensure compliance with this
507	507	14 section and the applicable provisions of the act.
508	508	2022 IN 1018—LS 6278/DI 104