SB502 (2016) Detail

Relative to the authority of the insurance commissioner to investigate violations of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act.


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SB 502-FN - AS INTRODUCED

 

2016 SESSION

\t16-2947

\t01/04

 

SENATE BILL\t502-FN

 

AN ACT\trelative to the authority of the insurance commissioner to investigate violations of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act.

 

SPONSORS:\tSen. Feltes, Dist 15; Sen. Bradley, Dist 3; Sen. Fuller Clark, Dist 21; Sen. Kelly, Dist 10; Sen. Reagan, Dist 17; Sen. Stiles, Dist 24; Sen. Watters, Dist 4; Sen. Woodburn, Dist 1; Rep. Kidder, Merr. 5; Rep. Butler, Carr. 7; Rep. Luneau, Merr. 10; Rep. Snow, Hills. 42; Rep. J. Ward, Rock. 19; Rep. LeBrun, Hills. 32; Rep. Rosenwald, Hills. 30; Rep. Sherman, Rock. 24

 

COMMITTEE:\tCommerce

 

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ANALYSIS

 

\tThis bill requires the insurance commissioner to investigate insurance carriers for conduct which may violate the provisions of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, as amended.

 

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Explanation:\tMatter added to current law appears in bold italics.

\t\tMatter removed from current law appears [in brackets and struckthrough.]

\t\tMatter which is either (a) all new or (b) repealed and reenacted appears in regular type.

\t16-2947

\t01/04

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Sixteen

 

AN ACT\trelative to the authority of the insurance commissioner to investigate violations of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act.

 

Be it Enacted by the Senate and House of Representatives in General Court convened:

 

\t1  New Subdivision; Mental Health Parity and Addiction Equity Enforcement.  Amend RSA 400-A by inserting after section 67 the following new subdivision:

Mental Health Parity and Addiction Equity Enforcement

\t400-A:68  Mental Health Parity and Addiction Equity Enforcement.

\t\tI.  The commissioner shall investigate insurance carrier conduct which may violate the provisions of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, as amended, hereinafter “Wellstone Domenici Parity Act.”  The commissioner shall conduct an initial assessment of all complaints and alleged violations of the Wellstone-Domenici Parity Act, refer assessed complaints to the appropriate authority if the complaints arise under the ERISA plan, fully investigate all complaints under the Wellstone-Domenici Parity Act within the commissioner's jurisdiction, and hold hearings relative to such conduct.  The commissioner may order restitution for a person or persons adversely affected by such insurance carrier conduct.

\t\tII.  The commissioner may request the assistance and services of the department of justice and shall delegate to the department of justice the authority to investigate alleged violations of the Wellstone-Domenici Parity Act if the insurance department is unable to perform this function or lacks jurisdiction.  The commissioner shall provide the department of justice information relevant to the number and type of complaints arising under the Wellstone-Domenici Parity Act and the investigation of such complaints, and shall cooperate with any such investigations or legal proceedings arising therefrom.

\t\tIII.  The commissioner may share documents, materials, or other information, including the confidential and privileged documents, materials, or other information, with the state and federal departments of justice and labor for the purpose of enforcing the Wellstone-Domenici Parity Act.

\t\tIV.  The department of justice may request information from the commissioner regarding complaints, investigations, and referrals arising under the Wellstone-Domenici Parity Act.

\t\tV.  The commissioner shall require insurance carriers to submit, and make public, annual reports specific to insurance carrier compliance with the Wellstone-Domenici Parity Act.  Such annual reports shall include, at a minimum, insurance carrier processes for determining provider reimbursement rates, determining reasonable access to care, evaluating benefit array to align with parity requirements, medical necessity criteria used for behavioral health disorders and determining quantitative treatment limitations, as required under the Wellstone-Domenici Parity Act.

\t\tVI.  The commissioner shall establish a mental health parity and addiction equity specific complaint process for consumers of mental health and addiction services.

\t2  Insurance Department; Investigations; Enforcement.  Amend RSA 400-A:16, III(d) to read as follows:

\t\t\t(d)  The commissioner [may] shall disclose to the public the number and nature of complaints and inquiries filed by consumers with the department; provided, however, no information exempt from disclosure under RSA 91-A shall be disclosed and no disclosure shall abridge the privacy interests of any consumer filing such a complaint or inquiry.

\t\t\t(e)  The commissioner shall share documents, materials, or other information, including the confidential and privileged documents, materials, or other information with the state and federal departments of justice and labor authorities for the purpose of investigating and enforcing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, as amended, as required under RSA 400-A:68.

\t3  New Paragraph; Examination for Violations of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, as amended.  Amend RSA 400-A:37 by inserting after paragraph I the following new paragraph:

\t\tI-a.  Examination for Violations of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, as amended.  The commissioner shall annually examine and evaluate domestic health insurers for compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, as amended.

\t4  Effective Date.  This act shall take effect upon its passage.

 

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SB 502-FN- FISCAL NOTE

 

AN ACT\trelative to the authority of the insurance commissioner to investigate violations of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act.

 

 

FISCAL IMPACT:

The Insurance Department and Department of Justice state this bill, as introduced, will increase state expenditures by an indeterminable amount in FY 2017 and each year thereafter.  There will be no impact on state, county and local revenue or on county and local expenditures.

 

METHODOLOGY:

The Insurance Department makes the following assumptions concerning the fiscal impact of this bill:

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  • The Insurance Department would investigate all alleged violations of the bill in accordance with RSA 400-A:16.  The Department would pay the cost of such investigations.  The average cost to investigate insurance carriers for these types of issues is $40,000 to $150,000.  The number of annual complaints is unknown, but the Department assumes a minimum of 8 complaints per year.
  • The Department would hold hearings for each alleged violation.  The average hearing would cost the Department $16,000 and there would be a minimum of 8 hearing per year.
  • The Department would share documents and investigation files with state and federal regulators.  There would be no significant cost to share information with state and federal regulators because the Department already has this ability and it is funded as part of their current budget.
  • The Department would require insurance carriers to submit annual reports and biannual provider directories.  There would be minimal additional cost for the Department to enforce annual reporting and to review and analyze this information.
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The Department is not able to determine the fiscal impact of the bill, but based on the assumptions above, the following additional annual expenditures would result from the bill and would be funded by the assessment paid by insurance carriers:

 

 

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Estimated Cost

Annual Amount

Investigations

8 Investigations @ $40,000 to $150,000 each

$320,000 to $1,200,000

Hearings

8 Hearings @ $16,000 each

$128,000

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The Department of Justice states this bill requires insurance carriers to investigate insurers for conduct that may violate the provisions of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.  The bill also provides that the Insurance Commissioner may request assistance from the Department of Justice for investigations.  The Department is not able to determine how many investigations would be referred and cannot determine the fiscal impact.  The Department assumes, since it does not have expertise in this area, it would need to outsource the investigations at cost estimated by the Insurance Department to be between $40,000 and $150,000.\t