PREFILED JAN 04 2023
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REFERENCE TITLE: mental health coverage; collaborative care |
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State of Arizona Senate Fifty-sixth Legislature First Regular Session 2023
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SB 1018 |
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Introduced by Senators Shope: Shamp
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An Act
amending section 20-2322, Arizona Revised Statutes; relating to accountable health plans.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 20-2322, Arizona Revised Statutes, is amended to read:
20-2322. Mental health services and benefits; definitions
A. Beginning on January 1, 1998, Any health benefits plan that is offered by an accountable health plan and that provides services or health benefits that include mental health services or mental health benefits shall comply with this section.
B. If the health benefits plan does not include an aggregate lifetime limit on substantially all health services or health benefits that are not related to mental health services or mental health benefits, the health benefits plan shall not impose any aggregate lifetime limit on mental health services or mental health benefits. If the health benefits plan includes an aggregate lifetime limit on substantially all health services or health benefits that are not related to mental health services or mental health benefits, the health benefits plan shall either:
1. Apply the applicable lifetime limit to both the health services or health benefits that are not related to mental health services or mental health benefits and to the mental health services or mental health benefits.
2. Not include an aggregate lifetime limit on mental health services or mental health benefits that is less than the applicable lifetime limit for health services or health benefits that are not related to mental health services or mental health benefits.
C. If the health benefits plan does not include an aggregate annual limit on substantially all health services or health benefits that are not related to mental health services or mental health benefits, the health benefits plan shall not impose any aggregate annual limit on mental health services or mental health benefits. If the health benefits plan includes an aggregate annual limit on substantially all health services or health benefits that are not related to mental health services or mental health benefits, the health benefits plan shall either:
1. Apply the applicable annual limit to both the health services or health benefits that are not related to mental health services or mental health benefits and to the mental health services or mental health benefits.
2. Not include any aggregate annual limit on mental health services or mental health benefits that is less than the applicable annual limit for health services or health benefits that are not related to mental health services or mental health benefits.
D. Except as provided in subsections A, B and C, this section does not prevent an accountable health plan that offers a health benefits plan that provides mental health services or mental health benefits from imposing terms and conditions, including cost sharing, limits on the number of visits or days of coverage or requirements relating to medical necessity in relation to the amount, duration or scope of coverage for mental health services or mental health benefits under the health benefits plan. Nothing in This section requires does not require an accountable health plan to:
1. Offer a health benefits plan that provides mental health services or mental health benefits.
2. Comply with this section in connection with any health benefits plan offered to a small employer.
3. 2. Comply with this section if that compliance under the health benefits plan offered by the accountable health plan would result in an increase in the cost to the health benefits plan of at least one per cent percent.
E. The requirements of this section apply separately to each health benefits plan offered by an accountable health plan and shall be consistent with title VII of the health insurance portability and accountability act of 1996 (P.L. 104-204; 110 Stat. 2944) and 45 Code of Federal Regulations part 146.
F. An entity that offers, issues or otherwise provides an individual or group health benefits plan that provides mental health services or mental health benefits shall provide reimbursement for the services or benefits that are delivered through the psychiatric collaborative care model, which shall include the following current procedural terminology billing codes established by the American medical association as of the effective date of this amendment to this section:
1. 99492.
2. 99493.
3. 99494.
G. The director shall adopt rules to update the current procedural terminology billing codes listed in subsection F of this section if there are any alterations or additions to the billing codes for the psychiatric collaborative care model.
H. An entity that offers, issues or otherwise provides an individual or group health benefits plan that provides mental health services or mental health benefits may deny reimbursement of any current procedural terminology billing code listed in subsection F of this section on the grounds of medical necessity if the medical necessity determination:
1. Complies with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (P.L. 110-33) and its implementing regulations.
2. Accords with the utilization review requirements established under Chapter 15 of this Title.
F. I. Mental health services or mental health benefits do not include benefits for the treatment of substance abuse or chemical dependency.
G. J. For the purposes of this section:
1. "Aggregate annual limit" means a dollar limitation on the total amount that may be paid in a twelve month period for benefits or services under a health benefits plan for an individual who is covered under a health benefits plan.
2. "Aggregate lifetime limit" means a dollar limitation on the total amount that may be paid for benefits or services under a health benefits plan for an individual who is covered under a health benefits plan.
3. "Psychiatric Collaborative Care Model" means the evidence-based, integrated behavioral health service delivery method published in the Federal Register, volume 81, number 220, November 15, 2016, page 80230.