OK
Oklahoma Senate Bill SB1413

Oklahoma 2022 Regular Session

Oklahoma Senate Bill SB1413 Compare Versions

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4-
5-An Act
6-ENROLLED SENATE
7-BILL NO. 1413 By: Montgomery of the Senate
28+ENGROSSED HOUSE AMENDME NT
29+ TO
30+ENGROSSED SENATE BILL NO . 1413 By: Montgomery of the Senate
831
932 and
1033
1134 Sneed of the House
35+
36+
1237
1338
1439
1540 An Act relating to mental health parity; amending 36
1641 O.S. 2021, Section 6060.11, which relates t o mental
1742 health coverage provision s; modifying contents to be
1843 reported in analyses; updating statutory references
1944 to comply with federal law; requiring analys is
2045 findings include certain provisions ; requiring
2146 Insurance Commissioner issue guidance and
2247 standardized reporting materials; updating statutory
2348 references; updating statutory language ; and
2449 providing an effective date.
2550
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2752
28-SUBJECT: Mental health parity
53+
54+AMENDMENT NO. 1. Page 4, lines 14 through 15, after the word
55+"benefit" and before the comma, strike the words
56+"including factors that were considered but
57+rejected"
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59+and amend title to conform
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86+Passed the House of Representatives the 26th day of April, 2022.
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92+Presiding Officer of the House of
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96+Passed the Senate the ____ day of _______ ___, 2022.
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131+ENGROSSED SENATE
132+BILL NO. 1413 By: Montgomery of the Senate
133+
134+ and
135+
136+ Sneed of the House
137+
138+
139+
140+
141+An Act relating to mental health parity; amending 36
142+O.S. 2021, Section 6060.11, which relates t o mental
143+health coverage provisions; modifying con tents to be
144+reported in analyses; updating statutory references
145+to comply with federal law; requiring analys is
146+findings include certain provisions ; requiring
147+Insurance Commissioner issue guidance and
148+standardized reporting materials; updating statutory
149+references; updating statutory language; and
150+providing an effective date.
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153+
29154
30155 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
31-
32156 SECTION 1. AMENDATORY 36 O.S. 2021, Secti on 6060.11, is
33157 amended to read as follows:
34-
35158 Section 6060.11. A. Subject to the limitations set forth in
36159 this section and Sections 6060.12 and 6060.13 o f this title, any
37160 health benefit plan that is o ffered, issued, or renewed in this
38161 state on or after the effective date of this act January 1, 2000,
39162 shall provide benefits for treatment of mental health and substance
40163 use disorders.
41-
42164 B. 1. Benefits for mental health and su bstance use disorders
43165 shall be equal to benefi ts for treatment of and shall be s ubject to
44166 the same preauthorization and utilization review mechanisms and
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45193 other terms and conditions as all other physical diseases and
46194 disorders including, but not limited to:
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49-ENR. S. B. NO. 1413 Page 2
50195 a. coverage of inpatient hospital services fo r either
51196 twenty-six (26) days or the limit for other covered
52197 illnesses, whichever is greater,
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54198 b. coverage of outpatient services,
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56199 c. coverage of medication,
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58200 d. maximum lifetime benefits,
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60201 e. copayments,
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62202 f. coverage of home health visits,
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64203 g. individual and family deductibles, and
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66204 h. coinsurance.
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68205 2. Treatment limitations applicable to mental health or
69206 substance use disorder benefits shall be no more restrictive than
70207 the predominant treatment limitations a pplied to substantially all
71208 medical and surgical benefi ts covered by the plan. There shall be
72209 no separate treatment limitations that are applicable only with
73210 respect to mental health or substance abuse disorder benefits.
74-
75211 C. A health benefit plan shall n ot impose a nonquantitative
76212 treatment limitation with re spect to mental health a nd substance use
77213 disorders in any classification of be nefits unless, under the terms
78214 of the health benefit plan as written and in operation, any
79215 processes, strategies, evidenti ary standards or other factors used
80216 in applying the nonq uantitative treatment li mitation to mental
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81243 health disorders in the classificat ion are comparable to and applied
82244 no more stringently than to medical and surgical benefits in the
83245 same classification.
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85246 D. All health benefit plans must meet the requirements of the
86247 federal Paul Wellstone and Pete Domenici Mental Health Parity and
87248 Addiction Equity Act of 2008, as amended, and federal guidance or
88249 regulations issued under these acts including 45 CFR 146.136, 45 CFR
89250 147.160, and 45 CFR 156.115(a)(3) , 42 U.S.C. 300gg-26(a), 29 U.S.C.
90251 1185a(a), and 26 U.S.C. 9812.
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93-ENR. S. B. NO. 1413 Page 3
94252 E. Beginning on or after the effective date of this act January
95253 1, 2000, each insurer that offers, issues or renews any individual
96254 or group health benefi t plan providing mental health or substance
97255 use disorder benefits shall subm it an annual report to the Insurance
98256 Commissioner on or before April 1 of each year that contains the
99257 following:
100-
101258 1. A description of th e process used to develop or select the
102259 medical necessity criteria for mental health and substance use
103260 disorder benefits and the process use d to develop or select the
104261 medical necessity criteria for medical and surgical benefits;
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106262 2. Identification of all n onquantitative treatment limitations
107263 applied to both mental health and substance use disorder bene fits
108264 and medical and surgical benefits wit hin each classificatio n of
109265 benefits; and
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111292 3. The results of an analysis that demonstrates that for the
112293 medical necessity criteria described in paragraph 1 of th is
113294 subsection and for each nonquantitative treatment l imitation
114295 identified in paragraph 2 of thi s subsection, as writt en and in
115296 operation, the processes, strategies, evidentiary standards or other
116297 factors used in applying the medical necessity criteria and each
117298 nonquantitative treatment limitation to mental h ealth and substance
118299 use disorder benefits within each classifica tion of benefits are
119300 comparable to and are applied no more stringently than to medical
120301 and surgical benefits in the same classification of benefits . At a
121302 minimum, the results of the analysis shall:
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123303 a. identify and clearly define the factors and terms used
124304 to determine that a nonquantitative treatment
125305 limitation will apply to a benefit including fac tors
126306 that were considered but rejected,
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128307 b. identify and clearly define the specific evi dentiary
129308 standards used to define the factors and an y other
130309 evidence relied upon in designing each nonquantitat ive
131310 treatment limitation,
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133311 c. provide the detailed, written, and re asoned
134312 comparative analyses in cluding the results of the
135313 analyses performed t o determine that the processes an d
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138314 strategies used to design each nonquantitative
139315 treatment limitation, as written, and the as written
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140342 processes and strategies used to appl y the
141343 nonquantitative treatment limit ation to mental health
142344 and substance use disord er benefits are comparable to
143345 and applied no more stringently than the processes and
144346 strategies used to de sign each nonquantitative
145347 treatment limitation, as written, and th e as written
146348 processes and strategies used to apply the
147349 nonquantitative treatment li mitation to medical and
148350 surgical benefits,
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150351 d. provide the detailed, written, and reasoned
151352 comparative analyses in cluding the results of the
152353 analyses performed to determine that th e processes and
153354 strategies used to apply each nonquantitative
154355 treatment limitation, in op eration, for mental health
155356 and substance use disorder benefits are comparable to
156357 and applied no more stringently than the processes or
157358 strategies used to apply each no nquantitative
158359 treatment limitation for medical and surgical benefits
159360 in the same classifi cation of benefits, and
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161361 e. disclose the specific findings and conclusions reached
162362 by the insurer that the results of the analyses
163363 required by this subsection indicate that whether the
164364 insurer is in compliance with this section and the
165365 Paul Wellstone and Pete Domenici Mental Health Pa rity
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166392 and Addiction Equity Act of 2008, as amended, and its
167393 implementing and related regulations including 45 CFR
168394 146.136, 45 CFR 147.160 , and 45 CFR 156.115(a)(3) , 42
169395 U.S.C. 300gg-26(a), 29 U.S.C. 1185a(a) , and 26 U.S.C.
170396 9812.
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172397 F. The findings and conclusions shall incl ude sufficient detail
173398 to fully explain such findings including methodologies for the
174399 analyses, detailed descriptions o f each treatment limitation for
175400 mental health and substance use disorder benefits compared to each
176401 treatment limitation for medical and surgical benefits, and detailed
177402 descriptions of all criteria involved for approving mental health
178403 and substance use disorder ben efits as compared to the criteria
179404 involved for approving medical and surgical benefits.
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181-ENR. S. B. NO. 1413 Page 5
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183405 G. The Commissioner shall implement and e nforce any applicable
184406 provisions of the Paul Wellst one and Pete Domenici Mental Health
185407 Parity and Addiction Equity Act of 2008, as amended, and federal
186408 guidance or regulations issued under these acts including 45 C FR
187409 146.136, 45 CFR 147.136, 45 CFR 147.160 , and 45 CFR 156.115(a)(3),
188410 42 U.S.C. 300gg-26(a), 29 U.S.C. 1185a(a), and 26 U.S.C. 9812.
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190411 H. The Commissioner shall issue guidance and standardized
191412 reporting templates to ensure compliance with the provisions of this
192413 section. Guidance shall include examples of non-quantitative
193414 treatment limitations as identifie d by the Centers for Medicare and
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194441 Medicaid Services, the Departmen t of Labor, and the Employee
195442 Benefits Security Administration.
196-
197443 G. I. No later than December 31, 2021, and by December 31 of
198444 each year thereafter, the Commissioner shall ma ke available to the
199445 public the reports submitted by insurers, as requi red in subsection
200446 E of this section, during the most recent annual cycle; provided,
201447 however, that any information that is confidential or a trade secret
202448 shall be redacted.
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204449 1. The Commissioner shall identify insurers that have failed in
205450 whole or in part to comply with the full extent of reporting
206451 required in this section and shall make a reasonable attemp t to
207452 obtain missing reports or information by June 1 of the following
208453 year.
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210454 2. The reports submitted by insurers and the identification by
211455 the Commissioner of noncompliant insurers shall be made available to
212456 the public by posting on the Internet website o f the Insurance
213457 Department. Any information that is confidentia l or a trade secret
214458 shall be redacted prior to the public posting.
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216459 H. J. The Commissioner shall may promulgate rules pursuant t o
217460 the provisions of thi s section and any provisions of the Paul
218461 Wellstone and Pete Domenici Mental Heal th Parity and Addiction
219462 Equity Act of 2008, as amended, that rel ate to the business of
220463 insurance.
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222464 SECTION 2. This act shall become effective November 1, 2022.
223465
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226-Passed the Senate the 12th day of May, 2022.
491+Passed the Senate the 14th day of March, 2022.
227492
228493
229494
230495 Presiding Officer of the Senate
231496
232497
233-Passed the House of Representatives the 26th day of April, 2022.
498+Passed the House of Representatives the ____ day of ______ ____,
499+2022.
234500
235501
236502
237503 Presiding Officer of the House
238504 of Representatives
239505
240-OFFICE OF THE GOVERNOR
241-Received by the Office of the Governor this _______ _____________
242-day of _________________ __, 20_______, at _______ o'clock ____ ___ M.
243-By: _____________________________ ____
244-Approved by the Governor of the State of Oklahoma this _____ ____
245-day of _________________ __, 20_______, at _______ o'clock _______ M.
246506
247- _________________________________
248- Governor of the State of Oklahoma
249-
250-
251-OFFICE OF THE SECRETARY OF STATE
252-Received by the Office of the Secretary of State this _______ ___
253-day of __________________, 20 _______, at _______ o'clock _______ M.
254-By: _______________________________ __