Indiana 2023 Regular Session

Indiana House Bill HB1095 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. 1095
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, 2023.
29	29	Shackleford
30	30	January 10, 2023, read first time and referred to Committee on Public Health.
31	31	2023 IN 1095—LS 6896/DI 104 Introduced
32	32	First Regular Session of the 123rd General Assembly (2023)
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 2022 Regular Session of the General Assembly.
42	42	HOUSE BILL No. 1095
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, 2023]: 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	2023 IN 1095—LS 6896/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, 2023. 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, 2023]: 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	2023 IN 1095—LS 6896/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 AMENDED BY
112	112	6 P.L.180-2022(ss), SECTION 16, IS AMENDED TO READ AS
113	113	7 FOLLOWS [EFFECTIVE JULY 1, 2023]: Sec. 3.5. (a) The plan must
114	114	8 include the following in a manner and to the extent determined by the
115	115	9 office:
116	116	10 (1) Mental health care services.
117	117	11 (2) Inpatient hospital services.
118	118	12 (3) Prescription drug coverage, including coverage of a long
119	119	13 acting, nonaddictive medication assistance treatment drug if the
120	120	14 drug is being prescribed for the treatment of substance abuse.
121	121	15 (4) Emergency room services.
122	122	16 (5) Physician office services.
123	123	17 (6) Diagnostic services.
124	124	18 (7) Outpatient services, including therapy services.
125	125	19 (8) Comprehensive disease management.
126	126	20 (9) Home health services, including case management.
127	127	21 (10) Urgent care center services.
128	128	22 (11) Preventative care services.
129	129	23 (12) Family planning services:
130	130	24 (A) including contraceptives and sexually transmitted disease
131	131	25 testing, as described in federal Medicaid law (42 U.S.C. 1396
132	132	26 et seq.); and
133	133	27 (B) not including abortion or abortifacients.
134	134	28 (13) Hospice services.
135	135	29 (14) Substance abuse services.
136	136	30 (15) Donated breast milk that meets requirements developed by
137	137	31 the office of Medicaid policy and planning.
138	138	32 (16) A service determined by the secretary to be required by
139	139	33 federal law as a benchmark service under the federal Patient
140	140	34 Protection and Affordable Care Act.
141	141	35 (b) The plan may not permit the following:
142	142	36 (1) Treatment limitations or financial requirements on the
143	143	37 coverage of mental health care services or substance abuse
144	144	38 services if similar limitations or requirements are not imposed on
145	145	39 the coverage of services for other medical or surgical conditions.
146	146	40 (2) In determining coverage for substance abuse treatment,
147	147	41 the plan may not factor in an individual's incarceration,
148	148	42 hospitalization, or other temporary cessation in substance or
149	149	2023 IN 1095—LS 6896/DI 104 4
150	150	1 chemical use when determining the individual's eligibility for
151	151	2 the treatment.
152	152	3 (c) The plan may provide vision services and dental services only
153	153	4 to individuals who regularly make the required monthly contributions
154	154	5 for the plan as set forth in section 4.7(c) of this chapter.
155	155	6 (d) The benefit package offered in the plan:
156	156	7 (1) must be benchmarked to a commercial health plan described
157	157	8 in 45 CFR 155.100(a)(1) or 45 CFR 155.100(a)(4); and
158	158	9 (2) may not include a benefit that is not present in at least one (1)
159	159	10 of these commercial benchmark options.
160	160	11 (e) The office shall provide to an individual who participates in the
161	161	12 plan a list of health care services that qualify as preventative care
162	162	13 services for the age, gender, and preexisting conditions of the
163	163	14 individual. The office shall consult with the federal Centers for Disease
164	164	15 Control and Prevention for a list of recommended preventative care
165	165	16 services.
166	166	17 (f) The plan shall, at no cost to the individual, provide payment of
167	167	18 preventative care services described in 42 U.S.C. 300gg-13 for an
168	168	19 individual who participates in the plan.
169	169	20 (g) The plan shall, at no cost to the individual, provide payments of
170	170	21 not more than five hundred dollars ($500) per year for preventative
171	171	22 care services not described in subsection (f). Any additional
172	172	23 preventative care services covered under the plan and received by the
173	173	24 individual during the year are subject to the deductible and payment
174	174	25 requirements of the plan.
175	175	26 (h) The office shall apply to the United States Department of Health
176	176	27 and Human Services for any amendment to the waiver necessary to
177	177	28 implement the providing of the services or supplies described in
178	178	29 subsection (a)(15). This subsection expires July 1, 2024.
179	179	30 SECTION 4. IC 12-21-9 IS ADDED TO THE INDIANA CODE AS
180	180	31 A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY
181	181	32 1, 2023]:
182	182	33 Chapter 9. Mental Health Education Program
183	183	34 Sec. 1. The division shall establish and administer a statewide
184	184	35 program to reduce the stigma of mental illness and addiction in
185	185	36 Indiana.
186	186	37 Sec. 2. The program must include the following:
187	187	38 (1) Awareness raising interventions, including signs or
188	188	39 symptoms that an individual may be suffering from a mental
189	189	40 illness or addiction.
190	190	41 (2) Literacy programs to improve knowledge of mental
191	191	42 illnesses and addiction.
192	192	2023 IN 1095—LS 6896/DI 104 5
193	193	1 (3) Dissemination of lists of resources available on a regional
194	194	2 basis to individuals who believe they are suffering from a
195	195	3 mental illness or addiction.
196	196	4 (4) The benefits of obtaining services to treat a mental illness
197	197	5 or addiction.
198	198	6 (5) Dissemination of educational materials targeted to
199	199	7 different ages and populations.
200	200	8 SECTION 5. IC 12-23-18-0.5, AS AMENDED BY P.L.8-2016,
201	201	9 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
202	202	10 JULY 1, 2023]: Sec. 0.5. (a) An opioid treatment program shall not
203	203	11 operate in Indiana unless the opioid treatment program meets the
204	204	12 following conditions:
205	205	13 (1) Is specifically approved and the opioid treatment facility is
206	206	14 certified by the division.
207	207	15 (2) Is in compliance with state and federal law.
208	208	16 (3) Provides treatment for opioid addiction using a drug approved
209	209	17 by the federal Food and Drug Administration for the treatment of
210	210	18 opioid addiction, including:
211	211	19 (A) opioid maintenance;
212	212	20 (B) detoxification;
213	213	21 (C) overdose reversal;
214	214	22 (D) relapse prevention; and
215	215	23 (E) long acting, nonaddictive medication assisted treatment
216	216	24 medications.
217	217	25 (4) Beginning July 1, 2017, is:
218	218	26 (A) enrolled:
219	219	27 (i) as a Medicaid provider under IC 12-15; and
220	220	28 (ii) as a healthy Indiana plan provider under IC 12-15-44.2;
221	221	29 or
222	222	30 (B) enrolled as an ordering, prescribing, or referring provider
223	223	31 in accordance with Section 6401 of the federal Patient
224	224	32 Protection and Affordable Care Act (P.L. 111-148), as
225	225	33 amended by the federal Health Care and Education
226	226	34 Reconciliation Act of 2010 (P.L. 111-152) and maintains a
227	227	35 memorandum of understanding with a community mental
228	228	36 health center for the purpose of ordering, prescribing, or
229	229	37 referring treatments covered by Medicaid and the healthy
230	230	38 Indiana plan.
231	231	39 (5) Provides to a patient of the opioid treatment facility who
232	232	40 is being released from the program referrals to appropriate
233	233	41 providers to continue the care that:
234	234	42 (A) the facility deems appropriate for the patient; or
235	235	2023 IN 1095—LS 6896/DI 104 6
236	236	1 (B) the patient requests;
237	237	2 before the patient's release from care of the facility.
238	238	3 (b) Separate specific approval and certification under this chapter
239	239	4 is required for each location at which an opioid treatment program is
240	240	5 operated. If an opioid treatment program moves the opioid treatment
241	241	6 program's facility to another location, the opioid treatment program's
242	242	7 certification does not apply to the new location and certification for the
243	243	8 new location under this chapter is required.
244	244	9 (c) Each opioid treatment program that is enrolled as an ordering,
245	245	10 prescribing, or referring provider shall report to the office on an annual
246	246	11 basis the services provided to Indiana Medicaid patients. The report
247	247	12 must include the following:
248	248	13 (1) The number of Medicaid patients seen by the ordering,
249	249	14 prescribing, or referring provider.
250	250	15 (2) The services received by the provider's Medicaid patients,
251	251	16 including any drugs prescribed.
252	252	17 (3) The number of Medicaid patients referred to other providers.
253	253	18 (4) Any other provider types to which the Medicaid patients were
254	254	19 referred.
255	255	20 SECTION 6. IC 12-23-18-5, AS AMENDED BY P.L.181-2021,
256	256	21 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
257	257	22 JULY 1, 2023]: Sec. 5. (a) The division shall adopt rules under
258	258	23 IC 4-22-2 to establish the following:
259	259	24 (1) Standards for operation of an opioid treatment program in
260	260	25 Indiana, including the following requirements:
261	261	26 (A) Except as otherwise prescribed by the division, an opioid
262	262	27 treatment program shall obtain prior authorization from the
263	263	28 division for any patient receiving more than fourteen (14) days
264	264	29 of opioid maintenance treatment medications at one (1) time
265	265	30 and the division may approve the authorization only under the
266	266	31 following circumstances:
267	267	32 (i) A physician licensed under IC 25-22.5 has issued an
268	268	33 order for the opioid treatment medication.
269	269	34 (ii) The patient has not tested positive under a drug test for
270	270	35 a drug for which the patient does not have a prescription for
271	271	36 a period of time set forth by the division.
272	272	37 (iii) The opioid treatment program has determined that the
273	273	38 benefit to the patient in receiving the take home opioid
274	274	39 treatment medication outweighs the potential risk of
275	275	40 diversion of the take home opioid treatment medication.
276	276	41 (B) Minimum requirements for a licensed physician's regular:
277	277	42 (i) physical presence in the opioid treatment facility; and
278	278	2023 IN 1095—LS 6896/DI 104 7
279	279	1 (ii) physical evaluation and progress evaluation of each
280	280	2 opioid treatment program patient.
281	281	3 (C) Minimum staffing requirements by licensed and
282	282	4 unlicensed personnel.
283	283	5 (D) Clinical standards for the appropriate tapering of a patient
284	284	6 on and off of an opioid treatment medication.
285	285	7 (E) The provision of counseling to female patients upon
286	286	8 admission and periodically through the patient's treatment
287	287	9 by the facility concerning the effects of the program
288	288	10 treatment if the female is or becomes pregnant, and the
289	289	11 provision to the patient of birth control if requested by the
290	290	12 patient.
291	291	13 (2) A requirement that, not later than February 28 of each year, a
292	292	14 current diversion control plan that meets the requirements of 21
293	293	15 CFR Part 290 and 42 CFR Part 8 be submitted for each opioid
294	294	16 treatment facility.
295	295	17 (3) Fees to be paid by an opioid treatment program for deposit in
296	296	18 the fund for annual certification under this chapter as described
297	297	19 in section 3 of this chapter.
298	298	20 The fees established under this subsection must be sufficient to pay the
299	299	21 cost of implementing this chapter.
300	300	22 (b) The division shall conduct an annual onsite visit of each opioid
301	301	23 treatment program facility to assess compliance with this chapter. As
302	302	24 part of an annual onsite visit, the division shall audit at least twenty
303	303	25 percent (20%) of the opioid treatment program facility's patient
304	304	26 plans to determine whether the facility is complying with federal
305	305	27 and state rules and regulations, including the following:
306	306	28 (1) Meeting tapering standards established by the division
307	307	29 under subsection (a)(1)(D).
308	308	30 (2) Complying with the goal of providing a patient with the
309	309	31 minimal clinically necessary medication dose, with the goal of
310	310	32 opioid abstinence as set forth in section 5.3 of this chapter.
311	311	33 (3) Performing and complying with the drug testing
312	312	34 requirements for patients set forth in section 2.5 of this
313	313	35 chapter.
314	314	36 (4) Racial demographics of the patients.
315	315	37 Any personally identifying information and medical information
316	316	38 of a patient obtained through the audit are confidential.
317	317	39 (c) Not later than April 1 of each year, the division shall report to
318	318	40 the general assembly in electronic format under IC 5-14-6 the
319	319	41 following information:
320	320	42 (1) The number of prior authorizations that were approved under
321	321	2023 IN 1095—LS 6896/DI 104 8
322	322	1 subsection (a)(1)(A) in the previous year and the:
323	323	2 (A) time frame for each approval; and
324	324	3 (B) duration of each approved treatment.
325	325	4 (2) The number of authorizations under subdivision (1) that were,
326	326	5 in the previous year, revoked due to a patient's violation of an
327	327	6 applicable term or condition.
328	328	7 (3) The number of each of the actions taken under section 5.8(a)
329	329	8 of this chapter in the previous year.
330	330	9 (4) The number and type of violations assessed for each action
331	331	10 specified in section 5.8(a) of this chapter in the previous year.
332	332	11 (d) A facility shall report, in a manner prescribed by the division, all
333	333	12 information required by the division to complete the report described
334	334	13 in subsection (c).
335	335	14 SECTION 7. IC 16-21-8.5 IS ADDED TO THE INDIANA CODE
336	336	15 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
337	337	16 JULY 1, 2023]:
338	338	17 Chapter 8.5. Emergency Room Treatment of Patients With
339	339	18 Substance Use Disorders
340	340	19 Sec. 1. Not later than January 1, 2024, a hospital licensed under
341	341	20 this article shall have established protocols on the emergency room
342	342	21 treatment of a patient who:
343	343	22 (1) is overdosing on a substance;
344	344	23 (2) has been provided an overdose intervention drug
345	345	24 immediately prior to being transported to the hospital; or
346	346	25 (3) is otherwise identified as having a substance use disorder.
347	347	26 Sec. 2. The protocols required in section 1 of this chapter must
348	348	27 include the following:
349	349	28 (1) An assessment of the patient before discharge by a
350	350	29 provider whose scope of practice includes providing
351	351	30 treatment for an individual with a substance use disorder,
352	352	31 including:
353	353	32 (A) a physician licensed under IC 25-22.5;
354	354	33 (B) a psychologist licensed under IC 25-33;
355	355	34 (C) an addiction counselor or a clinical addiction counselor
356	356	35 licensed under IC 25-23.6-10.5; or
357	357	36 (D) a person described in IC 25-23.6-10.1-2.
358	358	37 (2) Treatment, assistance in obtaining treatment, or a referral
359	359	38 to treatment to a provider described in subdivision (1).
360	360	39 Sec. 3. The hospital shall provide training on the protocols to
361	361	40 any staff or contractor providing services in the emergency
362	362	41 department of the hospital.
363	363	42 SECTION 8. IC 27-8-5-15.8, AS ADDED BY P.L.103-2020,
364	364	2023 IN 1095—LS 6896/DI 104 9
365	365	1 SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
366	366	2 JULY 1, 2023]: Sec. 15.8. (a) As used in this section, "treatment of a
367	367	3 mental illness or substance abuse" means:
368	368	4 (1) treatment for a mental illness, as defined in IC 12-7-2-130(1);
369	369	5 and
370	370	6 (2) treatment for drug abuse or alcohol abuse.
371	371	7 (b) As used in this section, "act" refers to the Paul Wellstone and
372	372	8 Pete Domenici Mental Health Parity and Addiction Act of 2008 and
373	373	9 any amendments thereto, plus any federal guidance or regulations
374	374	10 relevant to that act, including 45 CFR 146.136, 45 CFR 147.136, 45
375	375	11 CFR 147.160, and 45 CFR 156.115(a)(3).
376	376	12 (c) As used in this section, "nonquantitative treatment limitations"
377	377	13 refers to those limitations described in 26 CFR 54.9812-1, 29 CFR
378	378	14 2590.712, and 45 CFR 146.136.
379	379	15 (d) An insurer that issues a policy of accident and sickness
380	380	16 insurance that provides coverage of services for treatment of a mental
381	381	17 illness or substance abuse shall submit a report to the department not
382	382	18 later than December 31 of each year that contains the following
383	383	19 information:
384	384	20 (1) A description of the processes:
385	385	21 (A) used to develop or select the medical necessity criteria for
386	386	22 coverage of services for treatment of a mental illness or
387	387	23 substance abuse; and
388	388	24 (B) used to develop or select the medical necessity criteria for
389	389	25 coverage of services for treatment of other medical or surgical
390	390	26 conditions.
391	391	27 (2) Identification of all nonquantitative treatment limitations that
392	392	28 are applied to:
393	393	29 (A) coverage of services for treatment of a mental illness or
394	394	30 substance abuse; and
395	395	31 (B) coverage of services for treatment of other medical or
396	396	32 surgical conditions;
397	397	33 within each classification of benefits.
398	398	34 (e) Coverage of treatment of a mental illness or substance abuse
399	399	35 must meet the following:
400	400	36 (1) There may be no separate nonquantitative treatment
401	401	37 limitations that apply to coverage of services for treatment of a
402	402	38 mental illness or substance abuse that do not apply to coverage of
403	403	39 services for treatment of other medical or surgical conditions
404	404	40 within any classification of benefits.
405	405	41 (2) An individual's incarceration, hospitalization, or other
406	406	42 temporary cessation in substance or chemical use may not
407	407	2023 IN 1095—LS 6896/DI 104 10
408	408	1 factor into a determination of the individual's eligibility for
409	409	2 coverage of the treatment of mental illness or substance
410	410	3 abuse.
411	411	4 (f) An insurer that issues a policy of accident and sickness insurance
412	412	5 that provides coverage of services for treatment of a mental illness or
413	413	6 substance abuse shall also submit an analysis showing the insurer's
414	414	7 compliance with this section and the act to the department not later
415	415	8 than December 31 of each year. The analysis must do the following:
416	416	9 (1) Identify the factors used to determine that a nonquantitative
417	417	10 treatment limitation will apply to a benefit, including factors that
418	418	11 were considered but rejected.
419	419	12 (2) Identify and define the specific evidentiary standards used to
420	420	13 define the factors and any other evidence relied upon in designing
421	421	14 each nonquantitative treatment limitation.
422	422	15 (3) Provide the comparative analyses, including the results of the
423	423	16 analyses, performed to determine the following:
424	424	17 (A) That the processes and strategies used to design each
425	425	18 nonquantitative treatment limitation for coverage of services
426	426	19 for treatment of a mental illness or substance abuse are
427	427	20 comparable to, and applied no more stringently than, the
428	428	21 processes and strategies used to design each nonquantitative
429	429	22 treatment limitation for coverage of services for treatment of
430	430	23 other medical or surgical conditions.
431	431	24 (B) That the processes and strategies used to apply each
432	432	25 nonquantitative treatment limitation for treatment of a mental
433	433	26 illness or substance abuse are comparable to, and applied no
434	434	27 more stringently than, the processes and strategies used to
435	435	28 apply each nonquantitative limitation for treatment of other
436	436	29 medical or surgical conditions.
437	437	30 (g) The department shall adopt rules to ensure compliance with this
438	438	31 section and the applicable provisions of the act.
439	439	32 SECTION 9. IC 27-13-7-14.2, AS ADDED BY P.L.103-2020,
440	440	33 SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
441	441	34 JULY 1, 2023]: Sec. 14.2. (a) As used in this section, "treatment of a
442	442	35 mental illness or substance abuse" means:
443	443	36 (1) treatment for a mental illness, as defined in IC 12-7-2-130(1);
444	444	37 and
445	445	38 (2) treatment for drug abuse or alcohol abuse.
446	446	39 (b) As used in this section, "act" refers to the Paul Wellstone and
447	447	40 Pete Domenici Mental Health Parity and Addiction Act of 2008 and
448	448	41 any amendments thereto, plus any federal guidance or regulations
449	449	42 relevant to that act, including 45 CFR 146.136, 45 CFR 147.136, 45
450	450	2023 IN 1095—LS 6896/DI 104 11
451	451	1 CFR 147.160, and 45 CFR 156.115(a)(3).
452	452	2 (c) As used in this section, "nonquantitative treatment limitations"
453	453	3 refers to those limitations described in 26 CFR 54.9812-1, 29 CFR
454	454	4 2590.712, and 45 CFR 146.136.
455	455	5 (d) An individual contract or a group contract that provides
456	456	6 coverage of services for treatment of a mental illness or substance
457	457	7 abuse shall submit a report to the department not later than December
458	458	8 31 of each year that contains the following information:
459	459	9 (1) A description of the processes:
460	460	10 (A) used to develop or select the medical necessity criteria for
461	461	11 coverage of services for treatment of a mental illness or
462	462	12 substance abuse; and
463	463	13 (B) used to develop or select the medical necessity criteria for
464	464	14 coverage of services for treatment of other medical or surgical
465	465	15 conditions.
466	466	16 (2) Identification of all nonquantitative treatment limitations that
467	467	17 are applied to:
468	468	18 (A) coverage of services for treatment of a mental illness or
469	469	19 substance abuse; and
470	470	20 (B) coverage of services for treatment of other medical or
471	471	21 surgical conditions;
472	472	22 within each classification of benefits.
473	473	23 (e) Coverage of treatment of a mental illness or substance abuse
474	474	24 must meet the following:
475	475	25 (1) There may be no separate nonquantitative treatment
476	476	26 limitations that apply to coverage of services for treatment of a
477	477	27 mental illness or substance abuse that do not apply to coverage of
478	478	28 services for treatment of other medical or surgical conditions
479	479	29 within any classification of benefits.
480	480	30 (2) An individual's incarceration, hospitalization, or other
481	481	31 temporary cessation in substance or chemical use may not
482	482	32 factor into a determination of the individual's eligibility for
483	483	33 coverage of the treatment of mental illness or substance
484	484	34 abuse.
485	485	35 (f) An individual contract or a group contract that provides coverage
486	486	36 of services for treatment of a mental illness or substance abuse shall
487	487	37 also submit an analysis showing the insurer's compliance with this
488	488	38 section and the act to the department not later than December 31 of
489	489	39 each year. The analysis must do the following:
490	490	40 (1) Identify the factors used to determine that a nonquantitative
491	491	41 treatment limitation will apply to a benefit, including factors that
492	492	42 were considered but rejected.
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494	494	1 (2) Identify and define the specific evidentiary standards used to
495	495	2 define the factors and any other evidence relied upon in designing
496	496	3 each nonquantitative treatment limitation.
497	497	4 (3) Provide the comparative analyses, including the results of the
498	498	5 analyses, performed to determine the following:
499	499	6 (A) That the processes and strategies used to design each
500	500	7 nonquantitative treatment limitation for coverage of services
501	501	8 for treatment of a mental illness or substance abuse are
502	502	9 comparable to, and applied no more stringently than, the
503	503	10 processes and strategies used to design each nonquantitative
504	504	11 treatment limitation for coverage of services for treatment of
505	505	12 other medical or surgical conditions.
506	506	13 (B) That the processes and strategies used to apply each
507	507	14 nonquantitative treatment limitation for treatment of a mental
508	508	15 illness or substance abuse are comparable to, and applied no
509	509	16 more stringently than, the processes and strategies used to
510	510	17 apply each nonquantitative limitation for treatment of other
511	511	18 medical or surgical conditions.
512	512	19 (g) The department shall adopt rules to ensure compliance with this
513	513	20 section and the applicable provisions of the act.
514	514	2023 IN 1095—LS 6896/DI 104