ARIZONA HOUSE OF REPRESENTATIVES

Fifty-fourth Legislature

Second Regular Session

Senate: HHS DPA 8-0-0-0│APPROP DPA 9-0-0-0 │ 3rd Read 30-0-0-0

House: HHS DPA 9-0-0-0│APPROP DPA 10-0-0-1│ 3rd Read 30-0-0-0

SB1523/HB 2764: mental health omnibus.

Sponsor:  Representative Weninger, LD 17

Transmitted to the Governor

Overview

Grants the Arizona Department of Insurance (DOI) authority to enforce mental health parity, establishes the Mental Health Parity Advisory Committee, the Suicide Mortality Review Team and the Children's Behavioral Health Services Fund (Fund). Appropriates funds to the Department of Education, DOI and the Fund.

History

The Mental Health Parity and Addiction Equity Act of 2008 (Act) is a federal law that prevents health care insurers that provide mental health or substance use disorder benefits from imposing less favorable financial requirements and treatment limitations on mental health or substance use disorder benefits than on medical or surgical benefits. This Act does not require large group health plans or health insurers to cover mental health and substance use disorder benefits, and its requirements only apply to insurers that choose to include such benefits. However, the Affordable Care Act builds on the Mental Health Parity and Addiction Equity Act by requiring coverage of mental health and substance use disorder services as one of ten essential health benefits categories in certain plans. (CMS)

In 2018, $3 million were appropriated from the state General Fund (GF) to expand behavioral health benefits in schools. While $1 million of this funding is being used to provide mental health training to schools, the remaining funds are matched with federal funds to generate $10 million to bring behavioral health providers into school settings and to pay for Medicaid-covered behavioral health services in schools. The Arizona Health Care Cost Containment System (AHCCCS) helps schools connect with providers to meet students' behavioral health needs.

Provisions

Records; Identification Cards; Definitions

1.    Specifies that an insurer must comply with a request to produce documents or reports from an insurer's claim file or an insurer's record in compliance with mental health parity provisions. (Sec. 1)

2.    Includes adjustment of a claim in the definition of insurer claim file. (Sec. 1)

3.    Requires a member's health insurance identification card issued by a hospital and medical service corporation, health care services organization, or disability insurer to display the letters "AZDOI" and a customer service telephone number. (Sec. 2)

4.    Specifies that display requirements apply to identification cards for any individual or group contract, evidence of coverage or policy issued or renewed after December 31, 2021☐ Prop 105 (45 votes) ☐ Prop 108 (40 votes) ☐ Emergency (40 votes) ☐ Fiscal Note. (Sec. 2)

5.    Defines classification of benefits, health care insurer, health plan, Mental Health Parity and Addiction Equity Act, product network type and treatment limits. (Sec. 3)

Compliance with Federal Law; Report

6.    Requires a health care insurer to comply with the Act. (Sec. 3)

7.    Mandates that the director of DOI (Director) specify a date after January 1, 2022 by which each health care insurer must submit a report to DOI for each insured product network type the insurer issues. (Sec. 3)

8.    Requires reports to do the following:

a)    Describe the process that is used to develop the medical necessity criteria for mental health and substance use disorder benefits and the process to develop criteria for medical and surgical benefits;

b)    Identify nonquantitative treatment limits that are applied to mental health and substance use disorder benefits and to medical and surgical benefits within each benefit classification; and

c)    Demonstrate that for any nonquantitative treatment limit applied to mental health and substance use disorder benefits, any factor used in applying the limit is comparable to a factor used in applying a nonquantitative treatment limit for medical and surgical benefits in the same classification. (Sec. 3)

9.    Requires DOI to analyze insurer reports and evaluate health plan compliance with financial requirements and treatment limits. (Sec. 3)

10.  Permits DOI to require additional information from an insurer and to analyze an insurer's large group plans through a separate, consolidated report. (Sec. 3)

11.  Prohibits a health plan from applying a financial requirement or quantitative treatment limit to mental health and substance use disorder benefits that is more restrictive than the financial requirement or quantitative treatment limit applied to medical and surgical benefits in the same classification, unless the requirement or treatment limit is modified by one of the following:

a)    Multitiered prescription drug benefits;

b)    Multiple network tiers; or

c)    Subclassifications allowed for office visits that are separate from other outpatient services. (Sec. 3)

12.  Requires a health insurer to file the required report every three years. (Sec. 3)

13.  Requires a health insurer to file a summary of changes made to medical necessity criteria and nonquantitative treatment limits and a written attestation that states that the health care insurer is compliant with the Act in the years when a report is not required. (Sec. 3)

14.  Permits DOI to require an insurer to answer additional questions related to the summary of changes or to request additional data from an insurer that is necessary to verify compliance with the Act. (Sec. 3)

15.  Requires a health care insurer, three years after the original report is submitted, to either:

a)    File an updated report; or

b)    Resubmit the currently filed report if the insurer also files a written attestation to DOI that specifies that there have been no changes. (Sec. 3)

16.  Restricts DOI from requiring an additional filing or report from a health care insurer if the insurer has provided the required information in an existing filing or report. (Sec. 3)

17.  Requires DOI to analyze a health care insurer's existing filing or report to determine compliance with report requirements. (Sec. 3)

18.  Allows DOI to establish by rule the terms regarding required resubmittal of information. (Sec. 3)

19.  Specifies that all reports and documents provided by an insurer to the Director are confidential. (Sec. 3)

Enforcement and Oversight

20.  Requires DOI to enforce this chapter. (Sec. 3)

21.  Requires DOI to develop a web page by January 1, 2021, which provides in clear language the following:

a)    Information on the Act and the mental health parity requirements that apply to insurers;

b)    A step-by-step guide with supporting information that explains how consumers can file an appeal or complaint with DOI; and

c)    A link to the U.S. Department of Labor website or a related site that provides information on consumer appeals or complaints. (Sec. 3)

22.  Requires DOI, by January 1, 2023, to post to the web page a summary of the reports filed by insurers, including conclusions about industry compliance with the Act. (Sec. 3)

23.  Prohibits DOI from posting information that contains proprietary or confidential information of an insurer or enables a person to determine the identity of an insurer. (Sec. 3)

24.  Requires DOI to include in its annual report a summary of all stakeholder outreach and regulatory activity. (Sec. 3)

Access to Behavioral Health Services for Minors

25.  Prohibits an insurer that issues a health plan that includes mental health or substance use disorder benefits from denying a claim for mental health or substance use disorder benefits for a minor solely on the grounds that the service was provided in an educational setting or ordered by a court if the service was provided by an in-network or out-of-network provider as allowed by the health plan that covers the insured. (Sec. 3)

26.  Permits an insurer to reject a claim or refuse reimbursement for a service provided by an out-of-network provider. (Sec. 3)

27.  Allows an insurer to require that mental health or substance use disorder services provided in an educational setting be provided in an appropriate location and in a manner compliant with applicable laws, including privacy and parental consent laws. (Sec. 3)

28.  Specifies that claims for covered services that are provided by an out-of-network provider and that are not covered by an insured's health plan must be paid from the Children's Behavioral Health Services Fund. (Sec. 3)

Mental Health Parity Advisory Committee

29.  Establishes the Mental Health Parity Advisory Committee (Committee) to advise the Directors of DOI and DHS relating to matters of mental health parity. (Sec. 3)

30.  Outlines the requirements for members appointed to the Committee. (Sec. 3)

31.  Allows the Director of AHCCCS to serve in an advisory capacity at the request of the Director of DOI or the Director of DHS. (Sec. 3)

32.  Terminates the Committee on July 1, 2028. (Sec. 3)

Suicide Mortality Review Team

33.  Establishes the Suicide Mortality Review Team (Team). (Sec. 4)

34.  Outlines the requirements for members appointed to the Team. (Sec. 4)

35.  Requires the Team to:

a)    Develop a suicide mortalities data collection system;

b)    Conduct an annual analysis on the incidences and causes of suicides in Arizona in the preceding year;

c)    Assist in the development of local suicide mortality review teams;

d)    Develop standards for local suicide mortality review teams;

e)    Develop protocols for suicide investigations;

f)     Study the adequacy of statutes, ordinances, rules, training, and services to determine what changes are needed to prevent suicides and take appropriate steps to implement these changes;

g)    Educate the public on the causes and prevention of suicide; and

h)    Designate a member of the Team to serve as chairperson. (Sec. 4)

36.  Specifies that members of the Team cannot receive compensation but may receive reimbursement for expenses. (Sec. 4)

37.  Requires DHS to provide professional and administrative support to the Team. (Sec. 4)

38.  Terminates the Team on July 1, 2028. (Sec. 4)

Access to Information

39.  Allows the chairperson of the Team or a local team to request information and records regarding a suicide being reviewed by the Team, which they must be provided within five days. (Sec. 4)

40.  Allows the Team to request information from:

a)    A provider of medical, dental or mental health care;

b)    A health care insurer; or

c)    The state or political subdivision of the state. (Sec. 4)

41.  Allows a law enforcement agency to withhold records from a Team if they might interfere with a pending criminal investigation or prosecution. (Sec. 4)

42.  Allows the Director of DHS to apply to the superior court for a subpoena to compel the production of evidence related to a person who died by suicide and specifies that a subpoena must be served and enforced. (Sec. 4)

43.  Permits law enforcement to withhold information requested under a subpoena if the evidence relates to a pending criminal investigation or prosecution. (Sec. 4)

44.  Prohibits the Team from keeping records containing identifying information and requires records to be returned to the organization completing the review. (Sec. 4)

45.  Provides that all information and records obtained by the Team are confidential and not subject to subpoena, discovery or introduction into a civil or criminal proceeding unless they are available from other sources that are not immune from subpoena, discovery, or introduction into a civil or criminal proceeding. (Sec. 4)

46.  Prevents Team members and persons present at a Team meeting from being questioned in a civil or criminal proceeding regarding information presented in a meeting. (Sec. 4)

47.  Allows a Team member to contact, interview or obtain information by request or subpoena from a family member of a person who died by suicide if approved by the Team. (Sec. 4)

48.  Requires Team meetings to be closed to the public if the Team is reviewing information on a person who died by suicide and specifies that other Team meetings are open to the public. (Sec. 4)

49.  Specifies that a person who violates confidentiality requirements of this section is guilty of a class 2 misdemeanor. (Sec. 4)

Children's Behavioral Health Services Fund

50.  Establishes the Children's Behavioral Health Services Fund (Fund), consisting of appropriated monies, gifts or donations to the Fund and interest earned on those monies, and requires the Director of AHCCCS to administer the Fund. (Sec. 5)

51.  Stipulates that monies in the Fund are exempt from lapsing and are continuously appropriated. (Sec. 5)

52.  Requires AHCCCS to enter into an agreement with one or more contractors for children's behavioral health services using monies from the Fund and stipulates that children who receive behavioral health services paid by the Fund must be:

a)    Be within the legal age requirements for school admission at the time the student was admitted and be enrolled in school;

b)    Be uninsured or underinsured;

c)    Be referred by an educational institution;

d)    Have written parental consent to obtain services;

e)    Receive services from a licensed professional who is a contracted provider; and

f)     Receive services on or off school grounds. (Sec. 5)

53.  Specifies that the agreement must require that:

a)    The monies allocated not be used for persons who are eligible for Medicaid or the State Children's Health Insurance Program;

b)    Preference be given to persons with lower household incomes;

c)    The contractor make payments to providers based on contracts with providers or at the capped fee schedule established by the administration;

d)    The contractor submit monthly expenditure reports for reimbursement of services; and

e)    AHCCCS not be held financially responsible for costs incurred by the contractor in excess of the monies allocated in the agreement. (Sec. 5)

54.  Requires AHCCCS to act as the payor of last resort for eligible persons. (Sec. 5)

55.  Allows AHCCCS to impose cost sharing requirements on a sliding fee scale for services provided by contractors.

56.  Specifies that, upon receipt of services, a person is deemed to have assigned to AHCCCS all rights to any medical benefit to which the person is entitled. (Sec. 5)

57.  Specifies that this section does not establish entitlement for a person to receive a particular service or a duty for AHCCCS to provide services or spend monies in excess of monies in the fund. (Sec. 5)

School-based Behavioral Health Services

58.  Specifies that before a school can provide referrals for behavioral health services, the governing board must adopt policies relating to school-based referrals, including:

a)    A process to allow parents to annually opt into school-based referrals;

b)    A process to conduct a survey of parents whose children received services pursuant to this section, which must contain at least the following:

i.      Whether the parent opted into the program;

ii.     Whether the parent was notified before the referral took place;

iii.    Whether the services referred were appropriate for the student's needs;

iv.   Whether the parent is satisfied with the choice of providers; and

v.     Whether the parent intends to opt into a program again; and

c)    A requirement that the school website have a list of contracted providers. (Sec.5)

59.  Requires schools to annually report to AHCCCS the survey results. (Sec. 5)

60.  Requires AHCCCS to compile the survey results and provide a report. (Sec. 5)

Child Fatality Review Fund

61.  Requires DHS to use monies from the Child Fatality Review Fund to staff, train and support the Teams. (Sec. 6)

62.  Requires fee revenue in excess of $200,000, rather than $100,000, in any fiscal year to be appropriated from the Child Fatality Review Fund to the Child Abuse Prevention Fund. (Sec. 6)

AHCCCS Behavioral Health Survey of Schools

63.  Mandates that AHCCCS conduct a survey of public schools to obtain information on the referral of behavioral health services to students, including:

a)    The types of professionals providing services;

b)    The number of students who received students; and

c)    The most common diagnoses that resulted in the need for services. (Sec. 7)

64.  Requires AHCCCS to provide survey results by December 31, 2022. (Sec. 7)

65.  Repeals this section July 1, 2023. (Sec. 7)

Rulemaking: DOI

66.  Requires DOI, by April 1, 2021, to adopt by rule:

a)    Forms that healthcare insurers must use to prepare reports; and

b)    Standards to determine compliance with the Act. (Sec. 8)

67.  Allows DOI to allow health care insurers to demonstrate compliance with federal law by other means accepted by DOI. (Sec. 8)

68.  Requires the department, in developing the forms, to:

a)    Conduct workshops and listening sessions to obtain stakeholder input; and

b)    Review the U.S. Department of Labor's self-compliance tool for the Act. (Sec. 8)

Rulemaking: DHS

69.  Requires DHS to adopt rules on discharging patients who have attempted suicide or exhibit suicidal ideation and specifies that the rules must include protocols based on best practices for implementing discharge protocols and providing information to patients and caregivers on a continuum during the stay, including at admission and discharge. (Sec. 9)

70.  Stipulates that the rules address:  

a)    The availability and contact information of age appropriate crisis services;

b)    Information and referrals to the next level of care after discharge;

c)    Information on review and appeals processes, including referring patients and caregivers to information on the DOI website relating to how to challenge an adverse decision by a health care insurer or health plan; and

d)    Conducting a suicide assessment before discharging a patient and informing the patient and caregivers of the results. (Sec. 9)

71.  Exempts DHS from the rulemaking requirements for 18 months. DHS must provide public notice and an opportunity for public comment. (Sec. 9)

Appropriations

72.  Appropriates $250,000 and one FTE position from the state GF in FY 2021 to DOI to administer the statutes on mental health parity and exempts this appropriation from lapsing. (Sec. 10)

73.  Appropriates $8,000,000 from the state GF in FY 2021 to the Children's Behavioral Health Services Fund to pay contractors for services and specifies that the appropriation lapses on June 30, 2022. (Sec. 11)

Short Title

74.  Cites this act as Jake's Law. (Sec. 12)

 

 

 

---------- DOCUMENT FOOTER ---------

Initials IG/ML              Transmitted

 

---------- DOCUMENT FOOTER ---------