HB 7125 — AN ACT CONCERNING MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS.

General Assembly RaisedSubstitute Bill No.

7125 January Session, 2019 LCOAN No.ACT CONCERNING MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS.

4074 Referred to Committee on INSURANCE AND REAL ESTATE Introduced by:

(INS) AN ACT CONCERNING PARITY FOR MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS, NONQUANTITATIVE TREATMENT LIMITATIONS, DRUGS PRESCRIBED FOR THE TREATMENT OF SUBSTANCE USE DISORDERS, AND SUBSTANCE ABUSE SERVICES.

(2) "Mental health and substance use disorder benefits" means all benefits for the treatment of a mental health condition or a substance use disorder that (A) falls under one or more of the diagnostic categories listed in the chapter concerning mental disorders in the most recent edition of the WorldInternational Health Organization's "International Classification of Diseases",Diseases, or (B) is a mental disorder, as that term is defined in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders";

LCOand No.(3) "Nonquantitative treatment limitation" means a limitation that cannot be expressed numerically but otherwise limits the scope or duration of a covered benefit.

4074(b) 1Not oflater 10than RaisedMarch Bill1, No.71252021, and (3)annually "Nonquantitativethereafter, treatmenteach limitation"health meanscarrier ashall limitationsubmit thata cannotreport beto expressedthe numericallyInsurance butCommissioner, otherwisein limitsa theLCO scope\\PRDFS1\HCOUSERS\BARRYJN\WS\2019HB-07125-R01 orof duration10 ofHB.docx aSubstitute coveredBill benefit.No.

(b)7125 Not later than March 1, 2021, and annually thereafter, each health carrier shall submit a report to the Insurance Commissioner, Attorney General, Healthcare Advocate and executive director of the Office of Health Strategy, in a form and manner prescribed by the Insurancecommissioner, Commissioner, containing the following information for the calendar year immediately preceding:

(1) A description of the processes that such health carrier used to develop and select criteria to assess the medical necessity of (A) mental health and substance use disorder benefits, orand (B) medical and surgical benefits;

and (3) The results of an analysis concerning the processes, strategies, evidentiary standards and other factors that such health carrier used in developing and applying the criteria described in subdivision (1) of this subsection and each nonquantitative treatment limitation described in subdivision (2) of this subsection.subsection, provided the commissioner shall not disclose such results in a manner that is likely to compromise the financial, competitive or proprietary nature of such results.

(B) Disclose theany and all evidentiary standards, which standards thatmay suchbe healthqualitative carrieror appliedquantitative in consideringnature, theapplied factorsunder a factor described in subparagraph (A) of LCOthis No.subdivision, and, if no evidentiary standard is applied under such a factor, a clear description of such factor;

4074(C) 2Provide the comparative analyses, including the results of such analyses, performed to determine that the processes and strategies used to design each nonquantitative treatment limitation, as written, and the processes and strategies used to apply such nonquantitative LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2019HB-07122 of 10 RaisedR02-HB.docx Bill} No.7125Substitute thisBill subdivision;No.

and7125 (C) Disclose information that, in the opinion of the Insurance Commissioner, is sufficient to demonstrate that such health carrier (i) equally applied each nonquantitative treatment limitationlimitation, describedas inwritten, subdivision (2) of this subsection to (I) mental health and substance use disorder benefits,benefits andare (II)comparable medicalto, and surgicalapplied benefits,no andmore (ii)stringently compliedthan, withthe (I)processes sections 2 and 3strategies ofused thisto act,design (II)each sectionsnonquantitative 38a-488atreatment andlimitation, 38a-514as ofwritten, and the generalprocesses statutes, and (III)strategies theused Paulto Wellstoneapply andsuch Petenonquantitative Domenicitreatment Mentallimitation, Healthas Paritywritten, andto Addictionmedical Equityand Actsurgical ofbenefits; 2008, P.L.

(D) Provide the comparative analyses, including the results of such analyses, performed to determine that the processes and strategies used to apply each nonquantitative treatment limitation, in operation, to mental health and substance use disorder benefits are comparable to, and applied no more stringently than, the processes and strategies used to apply each nonquantitative treatment limitation, in operation, to medical and surgical benefits;

and (E) Disclose information that, in the opinion of the Insurance Commissioner, is sufficient to demonstrate that such health carrier (i) equally applied each nonquantitative treatment limitation described in subdivision (2) of this subsection to (I) mental health and substance use disorder benefits, and (II) medical and surgical benefits, and (ii) complied with (I) sections 2 and 3 of this act, (II) sections 38a-488a and 38a-514 of the general statutes, and (III) the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, P.L.

(c) Not later than March 15, 2021, and annually thereafter, the Insurance Commissioner shall submit,submit in accordance with section 11-4a of the general statutes, to the joint standing committee of the General Assembly having cognizance of matters relating to insurance each report that the commissioner received pursuant to subsection (b) of this section for the calendar year immediately preceding.preceding to:

(1) The joint standing committee of the General Assembly having cognizance of matters relating to insurance, in accordance with section 11-4a of the general statutes;

and (2) The Attorney General, Healthcare Advocate and executive LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2019HB-07123 of 10 R02-HB.docx } Substitute Bill No.

7125 director of the Office of Health Strategy.

The Insurance Commissioner, Attorneyor General, Healthcare Advocate and executive director of the Officecommissioner's ofdesignee, Health Strategy, or their designees, shall attend the public hearing and inform the committee whether, in theirthe commissioner's opinion, each health carrier, for the calendar year immediately preceding, (1) submitted a report pursuant to subsection (b) of this section that satisfies the requirements established in said subsection, and (2) complied with (A) sections 2 and 3 of this act, (B) sections 38a-488a38a- 488a and 38a-514 of the general statutes, and (C) the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, P.L.

LCO(e) No.The Insurance Commissioner may adopt regulations, in accordance with chapter 54 of the general statutes, to implement the provisions of this section.

4074 3 of 10 Raised Bill No.7125 (e) The Insurance Commissioner may adopt regulations, in accordance with chapter 54 of the general statutes, to implement the provisions of this section.

(NEW) (Effective January 1, 2020) No individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2020, shall apply a nonquantitative treatment limitation to mental health and substance use disorder benefits unless such policy also applies the nonquantitative treatment limitation to medical and surgical benefits.

(NEW) (Effective January 1, 2020) No group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4),LCO (11){\\PRDFS1\HCOUSERS\BARRYJN\WS\2019HB-07124 and (12) of section10 38a-469R02-HB.docx of} theSubstitute generalBill statutesNo. delivered, issued for delivery, renewed, amended or continued in this state shall apply a nonquantitative treatment limitation to mental health and substance use disorder benefits unless such policy also applies the nonquantitative treatment limitation to medical and surgical benefits.

7125 (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2020, shall apply a nonquantitative treatment limitation to mental health and substance use disorder benefits unless such policy also applies the nonquantitative treatment limitation to medical and surgical benefits.

(NEW) (Effective January 1, 2020) (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2020, that provides coverage for prescription drugs shall provide coverage for each prescription drug that is prescribed to aan personindividual covered under such policy for the treatment of a substance use disorder, provided use of such drug for such treatment is in compliance with approved federal Food and Drug Administration LCOindications. No.

4074 4 of 10 Raised Bill No.7125 indications.

(NEW) (Effective January 1, 2020) (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 of the generalLCO statutes{\\PRDFS1\HCOUSERS\BARRYJN\WS\2019HB-07125 delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for prescription drugs shall provide coverage for each prescription drug that is prescribed to a person covered under such policy for the treatment of a10 substanceR02-HB.docx use} disorder,Substitute providedBill useNo. of such drug for such treatment is in compliance with approved federal Food and Drug Administration indications.

7125 general statutes delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2020, that provides coverage for prescription drugs shall provide coverage for each prescription drug that is prescribed to an individual covered under such policy for the treatment of a substance use disorder, provided use of such drug for such treatment is in compliance with approved federal Food and Drug Administration indications.

LCOSec. No.

4074 5 of 10 Raised Bill No.7125 Sec.

(NEW) (Effective January 1, 2020) No individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes that is delivered, issued for delivery, renewed, amended or continued in this state shallon refuseor toafter provideJanuary 1, 2020, shall deny coverage for covered substance abuse services solely because such substance abuse services were provided pursuant to an order issued by a court of competent jurisdiction.

(NEW) (Effective January 1, 2020) No group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes that is delivered, issued for delivery, renewed, amended or continued in this state shallon refuseor toafter provideJanuary 1, 2020, shall deny coverage for covered substance abuse services solely because such substance abuse services were provided pursuant to an order issued by a court of competent jurisdiction.LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2019HB-07126 of 10 R02-HB.docx } Substitute Bill No.

7125 jurisdiction.

or (2) Require, if such insurance company, hospital service corporation, medical service corporation, health care center or other entity uses step therapy for such drugs, the use of step therapy for (A) any prescribed drug for longer than sixty days, or (B) a prescribed drug for cancer treatment for an insured who has been diagnosed with stage IV metastatic cancer, or a prescribed drug for the treatment of a substance LCOuse No.disorder, provided such prescribed drug is in compliance with approved federal Food and Drug Administration indications.

4074 6 of 10 Raised Bill No.7125 use disorder, provided such prescribed drug is in compliance with approved federal Food and Drug Administration indications.

If such provider does not deem such step therapy drug regimen clinically ineffective or has not requested anLCO override{\\PRDFS1\HCOUSERS\BARRYJN\WS\2019HB-07127 pursuant to subdivision (1) of subsection10 (b)R02-HB.docx of} thisSubstitute section,Bill suchNo. drug regimen may be continued.

7125 an override pursuant to subdivision (1) of subsection (b) of this section, such drug regimen may be continued.

or (2) Require, if such insurance company, hospital service corporation, medical service corporation, health care center or other entity uses step therapy for such drugs, the use of step therapy for (A) any prescribed LCOdrug No.for longer than sixty days, or (B) a prescribed drug for cancer treatment for an insured who has been diagnosed with stage IV metastatic cancer, or a prescribed drug for the treatment of a substance use disorder, provided such prescribed drug is in compliance with approved federal Food and Drug Administration indications.

4074(3) 7At the expiration of 10the Raisedtime Billperiod No.7125specified drugin forsubparagraph longer(A) thanof sixtysubdivision days,(2) of this subsection or (B)for a prescribed drug fordescribed cancerin treatmentsubparagraph for(B) anof insuredsubdivision who(2) hasof beenthis diagnosedsubsection, withan stageinsured's IVtreating metastatichealth cancer,care orprovider amay prescribeddeem such step therapy drug regimen clinically ineffective for the treatmentinsured, ofat awhich substancetime usethe disorder,insurance providedcompany, suchhospital prescribedservice drugcorporation, ismedical inservice compliancecorporation, withhealth approvedcare federalcenter Foodor andother Drugentity Administrationshall indications.authorize LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2019HB-07128 of 10 R02-HB.docx } Substitute Bill No.