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ENGROSSED HOUSE AMENDME NT
TO
ENGROSSED SENATE BILL NO . 1413 By: Montgomery of the Senate
and
Sneed of the House
An Act relating to mental health parity; amending 36
O.S. 2021, Section 6060.11, which relates t o mental
health coverage provision s; modifying contents to be
reported in analyses; updating statutory references
to comply with federal law; requiring analys is
findings include certain provisions ; requiring
Insurance Commissioner issue guidance and
standardized reporting materials; updating statutory
references; updating statutory language ; and
providing an effective date.
AMENDMENT NO. 1. Page 4, lines 14 through 15, after the word
"benefit" and before the comma, strike the words
"including factors that were considered but
rejected"
and amend title to conform
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Passed the House of Representatives the 26th day of April, 2022.
Presiding Officer of the House of
Representatives
Passed the Senate the ____ day of _______ ___, 2022.
Presiding Officer of the Senate
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ENGROSSED SENATE
BILL NO. 1413 By: Montgomery of the Senate
and
Sneed of the House
An Act relating to mental health parity; amending 36
O.S. 2021, Section 6060.11, which relates t o mental
health coverage provisions; modifying con tents to be
reported in analyses; updating statutory references
to comply with federal law; requiring analys is
findings include certain provisions ; requiring
Insurance Commissioner issue guidance and
standardized reporting materials; updating statutory
references; updating statutory language; and
providing an effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 36 O.S. 2021, Secti on 6060.11, is
amended to read as follows:
Section 6060.11. A. Subject to the limitations set forth in
this section and Sections 6060.12 and 6060.13 o f this title, any
health benefit plan that is o ffered, issued, or renewed in this
state on or after the effective date of this act January 1, 2000,
shall provide benefits for treatment of mental health and substance
use disorders.
B. 1. Benefits for mental health and su bstance use disorders
shall be equal to benefi ts for treatment of and shall be s ubject to
the same preauthorization and utilization review mechanisms and
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other terms and conditions as all other physical diseases and
disorders including, but not limited to:
a. coverage of inpatient hospital services fo r either
twenty-six (26) days or the limit for other covered
illnesses, whichever is greater,
b. coverage of outpatient services,
c. coverage of medication,
d. maximum lifetime benefits,
e. copayments,
f. coverage of home health visits,
g. individual and family deductibles, and
h. coinsurance.
2. Treatment limitations applicable to mental health or
substance use disorder benefits shall be no more restrictive than
the predominant treatment limitations a pplied to substantially all
medical and surgical benefi ts covered by the plan. There shall be
no separate treatment limitations that are applicable only with
respect to mental health or substance abuse disorder benefits.
C. A health benefit plan shall n ot impose a nonquantitative
treatment limitation with re spect to mental health a nd substance use
disorders in any classification of be nefits unless, under the terms
of the health benefit plan as written and in operation, any
processes, strategies, evidenti ary standards or other factors used
in applying the nonq uantitative treatment li mitation to mental
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health disorders in the classificat ion are comparable to and applied
no more stringently than to medical and surgical benefits in the
same classification.
D. All health benefit plans must meet the requirements of the
federal Paul Wellstone and Pete Domenici Mental Health Parity and
Addiction Equity Act of 2008, as amended, and federal guidance or
regulations issued under these acts including 45 CFR 146.136, 45 CFR
147.160, and 45 CFR 156.115(a)(3) , 42 U.S.C. 300gg-26(a), 29 U.S.C.
1185a(a), and 26 U.S.C. 9812.
E. Beginning on or after the effective date of this act January
1, 2000, each insurer that offers, issues or renews any individual
or group health benefi t plan providing mental health or substance
use disorder benefits shall subm it an annual report to the Insurance
Commissioner on or before April 1 of each year that contains the
following:
1. A description of th e process used to develop or select the
medical necessity criteria for mental health and substance use
disorder benefits and the process use d to develop or select the
medical necessity criteria for medical and surgical benefits;
2. Identification of all n onquantitative treatment limitations
applied to both mental health and substance use disorder bene fits
and medical and surgical benefits wit hin each classificatio n of
benefits; and
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3. The results of an analysis that demonstrates that for the
medical necessity criteria described in paragraph 1 of th is
subsection and for each nonquantitative treatment l imitation
identified in paragraph 2 of thi s subsection, as writt en and in
operation, the processes, strategies, evidentiary standards or other
factors used in applying the medical necessity criteria and each
nonquantitative treatment limitation to mental h ealth and substance
use disorder benefits within each classifica tion of benefits are
comparable to and are applied no more stringently than to medical
and surgical benefits in the same classification of benefits . At a
minimum, the results of the analysis shall:
a. identify and clearly define the factors and terms used
to determine that a nonquantitative treatment
limitation will apply to a benefit including fac tors
that were considered but rejected,
b. identify and clearly define the specific evi dentiary
standards used to define the factors and an y other
evidence relied upon in designing each nonquantitat ive
treatment limitation,
c. provide the detailed, written, and re asoned
comparative analyses in cluding the results of the
analyses performed t o determine that the processes an d
strategies used to design each nonquantitative
treatment limitation, as written, and the as written
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processes and strategies used to appl y the
nonquantitative treatment limit ation to mental health
and substance use disord er benefits are comparable to
and applied no more stringently than the processes and
strategies used to de sign each nonquantitative
treatment limitation, as written, and th e as written
processes and strategies used to apply the
nonquantitative treatment li mitation to medical and
surgical benefits,
d. provide the detailed, written, and reasoned
comparative analyses in cluding the results of the
analyses performed to determine that th e processes and
strategies used to apply each nonquantitative
treatment limitation, in op eration, for mental health
and substance use disorder benefits are comparable to
and applied no more stringently than the processes or
strategies used to apply each no nquantitative
treatment limitation for medical and surgical benefits
in the same classifi cation of benefits, and
e. disclose the specific findings and conclusions reached
by the insurer that the results of the analyses
required by this subsection indicate that whether the
insurer is in compliance with this section and the
Paul Wellstone and Pete Domenici Mental Health Pa rity
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and Addiction Equity Act of 2008, as amended, and its
implementing and related regulations including 45 CFR
146.136, 45 CFR 147.160 , and 45 CFR 156.115(a)(3) , 42
U.S.C. 300gg-26(a), 29 U.S.C. 1185a(a) , and 26 U.S.C.
9812.
F. The findings and conclusions shall incl ude sufficient detail
to fully explain such findings including methodologies for the
analyses, detailed descriptions o f each treatment limitation for
mental health and substance use disorder benefits compared to each
treatment limitation for medical and surgical benefits, and detailed
descriptions of all criteria involved for approving mental health
and substance use disorder ben efits as compared to the criteria
involved for approving medical and surgical benefits.
G. The Commissioner shall implement and e nforce any applicable
provisions of the Paul Wellst one and Pete Domenici Mental Health
Parity and Addiction Equity Act of 2008, as amended, and federal
guidance or regulations issued under these acts including 45 C FR
146.136, 45 CFR 147.136, 45 CFR 147.160 , and 45 CFR 156.115(a)(3),
42 U.S.C. 300gg-26(a), 29 U.S.C. 1185a(a), and 26 U.S.C. 9812.
H. The Commissioner shall issue guidance and standardized
reporting templates to ensure compliance with the provisions of this
section. Guidance shall include examples of non-quantitative
treatment limitations as identifie d by the Centers for Medicare and
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Medicaid Services, the Departmen t of Labor, and the Employee
Benefits Security Administration.
G. I. No later than December 31, 2021, and by December 31 of
each year thereafter, the Commissioner shall ma ke available to the
public the reports submitted by insurers, as requi red in subsection
E of this section, during the most recent annual cycle; provided,
however, that any information that is confidential or a trade secret
shall be redacted.
1. The Commissioner shall identify insurers that have failed in
whole or in part to comply with the full extent of reporting
required in this section and shall make a reasonable attemp t to
obtain missing reports or information by June 1 of the following
year.
2. The reports submitted by insurers and the identification by
the Commissioner of noncompliant insurers shall be made available to
the public by posting on the Internet website o f the Insurance
Department. Any information that is confidentia l or a trade secret
shall be redacted prior to the public posting.
H. J. The Commissioner shall may promulgate rules pursuant t o
the provisions of thi s section and any provisions of the Paul
Wellstone and Pete Domenici Mental Heal th Parity and Addiction
Equity Act of 2008, as amended, that rel ate to the business of
insurance.
SECTION 2. This act shall become effective November 1, 2022.
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Passed the Senate the 14th day of March, 2022.
Presiding Officer of the Senate
Passed the House of Representatives the ____ day of ______ ____,
2022.
Presiding Officer of the House
of Representatives