Indiana 2025 Regular Session

Indiana Senate Bill SB0446 Compare Versions

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

Old	New	Differences
1	1
2	2	Introduced Version
3	3	SENATE BILL No. 446
4	4	_____
5	5	DIGEST OF INTRODUCED BILL
6	6	Citations Affected: IC 27-8-5-15.8; IC 27-13-7-14.2.
7	7	Synopsis: Mental health and substance abuse coverage. Sets forth
8	8	certain standards regarding reimbursement rates for providers of
9	9	mental illness or substance abuse services. Provides that if a provider
10	10	of health care services that provides both medical or surgical services
11	11	and mental illness or substance abuse services is credentialed with an
12	12	insurer or health maintenance organization for purposes of providing
13	13	medical or surgical services, the provider must be considered
14	14	automatically credentialed for purposes of providing mental illness or
15	15	substance abuse services in instances under which the insurer provides
16	16	coverage of mental illness or substance abuse services through a third
17	17	party vendor.
18	18	Effective: Upon passage.
19	19	Crider
20	20	January 13, 2025, read first time and referred to Committee on Health and Provider
21	21	Services.
22	22	2025 IN 446—LS 7255/DI 141 Introduced
23	23	First Regular Session of the 124th General Assembly (2025)
24	24	PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
25	25	Constitution) is being amended, the text of the existing provision will appear in this style type,
26	26	additions will appear in this style type, and deletions will appear in this style type.
27	27	Additions: Whenever a new statutory provision is being enacted (or a new constitutional
28	28	provision adopted), the text of the new provision will appear in this style type. Also, the
29	29	word NEW will appear in that style type in the introductory clause of each SECTION that adds
30	30	a new provision to the Indiana Code or the Indiana Constitution.
31	31	Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
32	32	between statutes enacted by the 2024 Regular Session of the General Assembly.
33	33	SENATE BILL No. 446
34	34	A BILL FOR AN ACT to amend the Indiana Code concerning
35	35	insurance.
36	36	Be it enacted by the General Assembly of the State of Indiana:
37	37	1 SECTION 1. IC 27-8-5-15.8, AS ADDED BY P.L.103-2020,
38	38	2 SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
39	39	3 UPON PASSAGE]: Sec. 15.8. (a) As used in this section, "treatment
40	40	4 of a mental illness or substance abuse" means:
41	41	5 (1) treatment for a mental illness, as defined in IC 12-7-2-130(1);
42	42	6 and
43	43	7 (2) treatment for drug abuse or alcohol abuse.
44	44	8 (b) As used in this section, "act" refers to the Paul Wellstone and
45	45	9 Pete Domenici Mental Health Parity and Addiction Act of 2008 and
46	46	10 any amendments thereto, plus any federal guidance or regulations
47	47	11 relevant to that act, including 45 CFR 146.136, 45 CFR 147.136, 45
48	48	12 CFR 147.160, and 45 CFR 156.115(a)(3).
49	49	13 (c) As used in this section, "classifications of benefits" refers to
50	50	14 the classifications described in 45 CFR 146.136(c)(2)(ii).
51	51	15 (c) (d) As used in this section, "nonquantitative treatment
52	52	16 limitations" refers to those limitations described in 26 CFR 54.9812-1,
53	53	17 29 CFR 2590.712, and 45 CFR 146.136.
54	54	2025 IN 446—LS 7255/DI 141 2
55	55	1 (d) (e) An insurer that issues a policy of accident and sickness
56	56	2 insurance that provides coverage of services for treatment of a mental
57	57	3 illness or substance abuse shall submit a report to the department not
58	58	4 later than December 31 of each year that contains the following
59	59	5 information:
60	60	6 (1) A description of the processes:
61	61	7 (A) used to develop or select the medical necessity criteria for
62	62	8 coverage of services for treatment of a mental illness or
63	63	9 substance abuse; and
64	64	10 (B) used to develop or select the medical necessity criteria for
65	65	11 coverage of services for treatment of other medical or surgical
66	66	12 conditions.
67	67	13 (2) Identification of all nonquantitative treatment limitations that
68	68	14 are applied to:
69	69	15 (A) coverage of services for treatment of a mental illness or
70	70	16 substance abuse; and
71	71	17 (B) coverage of services for treatment of other medical or
72	72	18 surgical conditions;
73	73	19 within each classification of benefits.
74	74	20 (e) (f) There may be no separate nonquantitative treatment
75	75	21 limitations that apply to coverage of services for treatment of a mental
76	76	22 illness or substance abuse that do not apply to coverage of services for
77	77	23 treatment of other medical or surgical conditions within any
78	78	24 classification of benefits.
79	79	25 (f) (g) An insurer that issues a policy of accident and sickness
80	80	26 insurance that provides coverage of services for treatment of a mental
81	81	27 illness or substance abuse shall also submit an analysis showing the
82	82	28 insurer's compliance with this section and the act to the department not
83	83	29 later than December 31 of each year. The analysis must do the
84	84	30 following:
85	85	31 (1) Identify the factors used to determine that a nonquantitative
86	86	32 treatment limitation will apply to a benefit, including factors that
87	87	33 were considered but rejected.
88	88	34 (2) Identify and define the specific evidentiary standards used to
89	89	35 define the factors and any other evidence relied upon in designing
90	90	36 each nonquantitative treatment limitation.
91	91	37 (3) Provide the comparative analyses, including the results of the
92	92	38 analyses, performed to determine the following:
93	93	39 (A) That the processes and strategies used to design each
94	94	40 nonquantitative treatment limitation for coverage of services
95	95	41 for treatment of a mental illness or substance abuse are
96	96	42 comparable to, and applied no more stringently than, the
97	97	2025 IN 446—LS 7255/DI 141 3
98	98	1 processes and strategies used to design each nonquantitative
99	99	2 treatment limitation for coverage of services for treatment of
100	100	3 other medical or surgical conditions.
101	101	4 (B) That the processes and strategies used to apply each
102	102	5 nonquantitative treatment limitation for treatment of a mental
103	103	6 illness or substance abuse are comparable to, and applied no
104	104	7 more stringently than, the processes and strategies used to
105	105	8 apply each nonquantitative limitation for treatment of other
106	106	9 medical or surgical conditions.
107	107	10 (4) Provide the information on reimbursement rates described
108	108	11 in subsections (h), (i), and (k).
109	109	12 (h) The department shall deem an insurer that issues a policy of
110	110	13 accident and sickness insurance that provides coverage of services
111	111	14 for treatment of a mental illness or substance abuse in compliance
112	112	15 with the act in terms of reimbursement rates in a classification of
113	113	16 benefits if reimbursement rates for providers of mental illness or
114	114	17 substance abuse services are at least as favorable relative to
115	115	18 Medicare rates as reimbursement rates are for providers of
116	116	19 medical or surgical services relative to Medicare rates in the
117	117	20 respective classification of benefits.
118	118	21 (i) The department shall perform a deeper examination of an
119	119	22 insurer that issues a policy of accident and sickness insurance that
120	120	23 provides coverage of services for treatment of a mental illness or
121	121	24 substance abuse for possible noncompliance with the act under
122	122	25 circumstances in which reimbursement rates for providers of
123	123	26 mental illness or substance abuse services in a classification of
124	124	27 benefits are at least ten percent (10%) lower relative to Medicare
125	125	28 rates than reimbursement rates for providers of medical or
126	126	29 surgical benefits relative to Medicare rates in the respective
127	127	30 classification of benefits.
128	128	31 (j) If a provider of health care services that provides both
129	129	32 medical or surgical services and mental illness or substance abuse
130	130	33 services is credentialed with an insurer that issues a policy of
131	131	34 accident and sickness insurance for purposes of providing medical
132	132	35 or surgical services, the provider must be considered automatically
133	133	36 credentialed for purposes of providing mental illness or substance
134	134	37 abuse services in instances under which the insurer provides
135	135	38 coverage of mental illness or substance abuse services through a
136	136	39 third party vendor.
137	137	40 (g) (k) The department shall adopt rules:
138	138	41 (1) for purposes of determining the value of reimbursement
139	139	42 rates relative to Medicare rates, as described in subsections
140	140	2025 IN 446—LS 7255/DI 141 4
141	141	1 (h) and (i); and
142	142	2 (2) to ensure compliance with this section and the applicable
143	143	3 provisions of the act.
144	144	4 SECTION 2. IC 27-13-7-14.2, AS ADDED BY P.L.103-2020,
145	145	5 SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
146	146	6 UPON PASSAGE]: Sec. 14.2. (a) As used in this section, "treatment
147	147	7 of a mental illness or substance abuse" means:
148	148	8 (1) treatment for a mental illness, as defined in IC 12-7-2-130(1);
149	149	9 and
150	150	10 (2) treatment for drug abuse or alcohol abuse.
151	151	11 (b) As used in this section, "act" refers to the Paul Wellstone and
152	152	12 Pete Domenici Mental Health Parity and Addiction Act of 2008 and
153	153	13 any amendments thereto, plus any federal guidance or regulations
154	154	14 relevant to that act, including 45 CFR 146.136, 45 CFR 147.136, 45
155	155	15 CFR 147.160, and 45 CFR 156.115(a)(3).
156	156	16 (c) As used in this section, "classifications of benefits" refers to
157	157	17 the classifications described in 45 CFR 146.136(c)(2)(ii).
158	158	18 (c) (d) As used in this section, "nonquantitative treatment
159	159	19 limitations" refers to those limitations described in 26 CFR 54.9812-1,
160	160	20 29 CFR 2590.712, and 45 CFR 146.136.
161	161	21 (d) (e) An individual contract or a group contract that provides
162	162	22 coverage of services for treatment of a mental illness or substance
163	163	23 abuse shall submit a report to the department not later than December
164	164	24 31 of each year that contains the following information:
165	165	25 (1) A description of the processes:
166	166	26 (A) used to develop or select the medical necessity criteria for
167	167	27 coverage of services for treatment of a mental illness or
168	168	28 substance abuse; and
169	169	29 (B) used to develop or select the medical necessity criteria for
170	170	30 coverage of services for treatment of other medical or surgical
171	171	31 conditions.
172	172	32 (2) Identification of all nonquantitative treatment limitations that
173	173	33 are applied to:
174	174	34 (A) coverage of services for treatment of a mental illness or
175	175	35 substance abuse; and
176	176	36 (B) coverage of services for treatment of other medical or
177	177	37 surgical conditions;
178	178	38 within each classification of benefits.
179	179	39 (e) (f) There may be no separate nonquantitative treatment
180	180	40 limitations that apply to coverage of services for treatment of a mental
181	181	41 illness or substance abuse that do not apply to coverage of services for
182	182	42 treatment of other medical or surgical conditions within any
183	183	2025 IN 446—LS 7255/DI 141 5
184	184	1 classification of benefits.
185	185	2 (f) (g) An individual contract or a group contract that provides
186	186	3 coverage of services for treatment of a mental illness or substance
187	187	4 abuse shall also submit an analysis showing the insurer's compliance
188	188	5 with this section and the act to the department not later than December
189	189	6 31 of each year. The analysis must do the following:
190	190	7 (1) Identify the factors used to determine that a nonquantitative
191	191	8 treatment limitation will apply to a benefit, including factors that
192	192	9 were considered but rejected.
193	193	10 (2) Identify and define the specific evidentiary standards used to
194	194	11 define the factors and any other evidence relied upon in designing
195	195	12 each nonquantitative treatment limitation.
196	196	13 (3) Provide the comparative analyses, including the results of the
197	197	14 analyses, performed to determine the following:
198	198	15 (A) That the processes and strategies used to design each
199	199	16 nonquantitative treatment limitation for coverage of services
200	200	17 for treatment of a mental illness or substance abuse are
201	201	18 comparable to, and applied no more stringently than, the
202	202	19 processes and strategies used to design each nonquantitative
203	203	20 treatment limitation for coverage of services for treatment of
204	204	21 other medical or surgical conditions.
205	205	22 (B) That the processes and strategies used to apply each
206	206	23 nonquantitative treatment limitation for treatment of a mental
207	207	24 illness or substance abuse are comparable to, and applied no
208	208	25 more stringently than, the processes and strategies used to
209	209	26 apply each nonquantitative limitation for treatment of other
210	210	27 medical or surgical conditions.
211	211	28 (4) Provide the information on reimbursement rates described
212	212	29 in subsections (h), (i), and (k).
213	213	30 (h) The department shall deem a health maintenance
214	214	31 organization that enters into an individual contract or a group
215	215	32 contract that provides coverage of services for treatment of a
216	216	33 mental illness or substance abuse in compliance with the act in
217	217	34 terms of reimbursement rates in a classification of benefits if
218	218	35 reimbursement rates for providers of mental illness or substance
219	219	36 abuse services are at least as favorable relative to Medicare rates
220	220	37 as reimbursement rates are for providers of medical or surgical
221	221	38 services relative to Medicare rates in the respective classification
222	222	39 of benefits.
223	223	40 (i) The department shall perform a deeper examination of a
224	224	41 health maintenance organization that enters into an individual
225	225	42 contract or a group contract that provides coverage of services for
226	226	2025 IN 446—LS 7255/DI 141 6
227	227	1 treatment of a mental illness or substance abuse for possible
228	228	2 noncompliance with the act under circumstances in which
229	229	3 reimbursement rates for providers of mental illness or substance
230	230	4 abuse services in a classification of benefits are at least ten percent
231	231	5 (10%) lower relative to Medicare rates than reimbursement rates
232	232	6 for providers of medical or surgical benefits relative to Medicare
233	233	7 rates in the respective classification of benefits.
234	234	8 (j) If a provider of health care services that provides both
235	235	9 medical or surgical services and mental illness or substance abuse
236	236	10 services is credentialed with a health maintenance organization for
237	237	11 purposes of providing medical or surgical services, the provider
238	238	12 must be considered automatically credentialed for purposes of
239	239	13 providing mental illness or substance abuse services in instances
240	240	14 under which the health maintenance organization provides
241	241	15 coverage of mental illness or substance abuse services through a
242	242	16 third party vendor.
243	243	17 (g) (k) The department shall adopt rules:
244	244	18 (1) for purposes of determining the value of reimbursement
245	245	19 rates relative to Medicare rates, as described in subsections
246	246	20 (h) and (i); and
247	247	21 (2) to ensure compliance with this section and the applicable
248	248	22 provisions of the act.
249	249	23 SECTION 3. An emergency is declared for this act.
250	250	2025 IN 446—LS 7255/DI 141