Reimbursement rate parity for clinical trainees providing alcoholism, mental health, and chemical dependency services required.

A bill for an act

relating to health insurance; requiring reimbursement rate parity for clinical trainees

providing alcoholism, mental health, and chemical dependency services; amending

Minnesota Statutes 2024, section 62Q.47.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2024, section 62Q.47, is amended to read:

62Q.47 ALCOHOLISM, MENTAL HEALTH, AND CHEMICAL DEPENDENCY

SERVICES.

(a) All health plans, as defined in section
62Q.01
, that provide coverage for alcoholism,

mental health, or chemical dependency services, must comply with the requirements of this

section.

(b) Cost-sharing requirements and benefit or service limitations for outpatient mental

health and outpatient chemical dependency and alcoholism services, except for persons

seeking chemical dependency services under section 245G.05, must not place a greater

financial burden on the insured or enrollee, or be more restrictive than those requirements

and limitations for outpatient medical services.

(c) Cost-sharing requirements and benefit or service limitations for inpatient hospital

mental health services, psychiatric residential treatment facility services, and inpatient

hospital and residential chemical dependency and alcoholism services, except for persons

seeking chemical dependency services under section 245G.05, must not place a greater

financial burden on the insured or enrollee, or be more restrictive than those requirements

and limitations for inpatient hospital medical services.

(d) A health plan company must not impose an NQTL with respect to mental health and

substance use disorders in any classification of benefits unless, under the terms of the health

plan as written and in operation, any processes, strategies, evidentiary standards, or other

factors used in applying the NQTL to mental health and substance use disorders in the

classification are comparable to, and are applied no more stringently than, the processes,

strategies, evidentiary standards, or other factors used in applying the NQTL with respect

to medical and surgical benefits in the same classification.

(e) All health plans must meet the requirements of the federal Mental Health Parity Act

of 1996, Public Law 104-204; Paul Wellstone and Pete Domenici Mental Health Parity and

Addiction Equity Act of 2008; the Affordable Care Act; and any amendments to, and federal

guidance or regulations issued under, those acts.

(f) The commissioner may require information from health plan companies to confirm

that mental health parity is being implemented by the health plan company. Information

required may include comparisons between mental health and substance use disorder

treatment and other medical conditions, including a comparison of prior authorization

requirements, drug formulary design, claim denials, rehabilitation services, and other

information the commissioner deems appropriate.

(g) Regardless of the health care provider's professional license, if the service provided

is consistent with the provider's scope of practice and the health plan company's credentialing

and contracting provisions, mental health therapy visits and medication maintenance visits

shall be considered primary care visits for the purpose of applying any enrollee cost-sharing

requirements imposed under the enrollee's health plan.

(h) All health plan companies offering health plans that provide coverage for alcoholism,

mental health, or chemical dependency benefits shall provide reimbursement for the benefits

delivered through the psychiatric Collaborative Care Model, which must include the following

Current Procedural Terminology or Healthcare Common Procedure Coding System billing

codes:

(1) 99492;

(2) 99493;

(3) 99494;

(4) G2214; and

(5) G0512.

This paragraph does not apply to managed care plans or county-based purchasing plans

when the plan provides coverage to public health care program enrollees under chapter

256B or 256L.

(i) The commissioner of commerce shall update the list of codes in paragraph (h) if any

alterations or additions to the billing codes for the psychiatric Collaborative Care Model

are made.

(j) "Psychiatric Collaborative Care Model" means the evidence-based, integrated

behavioral health service delivery method described at Federal Register, volume 81, page

80230, which includes a formal collaborative arrangement among a primary care team

consisting of a primary care provider, a care manager, and a psychiatric consultant, and

includes but is not limited to the following elements:

(1) care directed by the primary care team;

(2) structured care management;

(3) regular assessments of clinical status using validated tools; and

(4) modification of treatment as appropriate.

(k) By June 1 of each year, beginning June 1, 2021, the commissioner of commerce, in

consultation with the commissioner of health, shall submit a report on compliance and

oversight to the chairs and ranking minority members of the legislative committees with

jurisdiction over health and commerce. The report must:

(1) describe the commissioner's process for reviewing health plan company compliance

with United States Code, title 42, section 18031(j), any federal regulations or guidance

relating to compliance and oversight, and compliance with this section and section
62Q.53
;

(2) identify any enforcement actions taken by either commissioner during the preceding

12-month period regarding compliance with parity for mental health and substance use

disorders benefits under state and federal law, summarizing the results of any market conduct

examinations. The summary must include: (i) the number of formal enforcement actions

taken; (ii) the benefit classifications examined in each enforcement action; and (iii) the

subject matter of each enforcement action, including quantitative and nonquantitative

treatment limitations;

(3) detail any corrective action taken by either commissioner to ensure health plan

company compliance with this section, section
62Q.53
, and United States Code, title 42,

section 18031(j); and

(4) describe the information provided by either commissioner to the public about

alcoholism, mental health, or chemical dependency parity protections under state and federal

law.

The report must be written in nontechnical, readily understandable language and must be

made available to the public by, among other means as the commissioners find appropriate,

posting the report on department websites. Individually identifiable information must be

excluded from the report, consistent with state and federal privacy protections.

new text begin

(l) Health plans must reimburse all alcoholism, mental health, and chemical dependency

services provided by clinical trainees, pursuant to section 245I.04, subdivision 6, at a rate

at least equal to 100 percent of the rate which would be paid to an independently licensed

mental health professional performing the same services. This paragraph does not apply if

the service provided by the clinical trainee is not within the clinical trainee's scope of practice

under section 245I.04, subdivision 7.

new text end

new text begin

EFFECTIVE DATE.

new text end

new text begin

This section is effective January 1, 2027, for health plans offered,

issued, sold, or renewed on or after that date.

new text end