SB620 (2020) Detail

Relative to coverage for certain biologically-based mental illnesses.


SB 620-FN - AS AMENDED BY THE SENATE

 

03/11/2020   1056s

2020 SESSION

20-2866

01/04

 

SENATE BILL 620-FN

 

AN ACT relative to coverage for certain biologically-based mental illnesses.

 

SPONSORS: Sen. Sherman, Dist 24; Sen. Watters, Dist 4; Sen. Hennessey, Dist 5; Rep. Indruk, Hills. 34; Rep. Fothergill, Coos 1; Rep. Marsh, Carr. 8; Rep. Woods, Merr. 23

 

COMMITTEE: Commerce

 

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ANALYSIS

 

This bill requires insurers providing benefits for treatment and diagnosis of certain biologically-based mental illnesses and substance use disorders to submit an annual report to the insurance commissioner demonstrating compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Equity Act of 2008.

 

The bill also clarifies authorization for medication-assisted treatment.

 

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03/11/2020   1056s 20-2866

01/04

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Twenty

 

AN ACT relative to coverage for certain biologically-based mental illnesses.

 

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

 

1  New Paragraph; Coverage for Certain Biologically-Based Mental Illnesses; Reimbursement Parity Required.  Amend RSA 417-E:1 by inserting after paragraph V-a the following new paragraph:

V-b.(a)  Health insurers, health service corporations, and health maintenance organizations shall include in their contracts with participating providers as defined under 420-J:3, reimbursement terms for mental health and substance use disorder treatment services that are on average, at least as favorable as those in their contracts with primary care providers.  Reimbursement rates paid to mental health and substance use disorder treatment providers shall meet the required standard if the relative percentage of what Medicare pays for the same service, is on average, equal to or greater than that paid to primary care providers.  Services considered in the comparison shall include both physician and non-physician in-network professional providers located in New Hampshire.  

(b)  Compliance with subparagraph (a) shall not constitute compliance with the Mental Health Parity and Addiction Equity Act in 42 U.S.C. 300gg-26 and its implementing and related regulations in 45 C.F.R. 146.136, 45 C.F.R. 147.160, and 45 C.F.R. 156.115(a)(3).  Health insurers, health service corporations, and health maintenance organizations shall, pursuant to 45 C.F.R. 146.136(c)(4)(i) and 45 C.F.R. 146.136(c)(4)(ii), ensure that when setting reimbursement rates for mental health and substance use disorder treatment providers, as written and in effect, any processes, strategies, evidentiary standards, or other factors used in establishing such reimbursement rates are comparable to, and are applied no more stringently than, any processes, strategies, evidentiary standards, or other factors used in establishing reimbursement rates for medical/surgical providers in the classification of benefits.  

2  Managed Care Law: Authorization for Medication- Assisted Treatment.  Amend RSA 420-J:18 to read as follows:

420-J:18  Authorization for Medication-Assisted Treatment.  Whenever substance use disorder services are a covered benefit under a health benefit plan subject to this chapter, a health carrier [that has authorized or otherwise approved medication-assisted treatment for such services shall not require a renewal of such authorization more frequently than once every 12 months.] shall:

I.  Not impose any prior authorization requirements on any prescription medication approved by the federal Food and Drug Administration (FDA) for the treatment of substance use disorders.

II.  Not impose any step therapy requirements before the health carrier will authorize coverage for a prescription medication approved by the FDA for the treatment of substance use disorders.

III.  Place all prescription medications approved by the FDA for the treatment of substance use disorders on the lowest tier of the drug formulary developed and maintained by the health carrier.

IV.  Not exclude coverage for any prescription medication approved by the FDA for the treatment of substance use disorders and any associated counseling or wraparound services on the grounds that such medications and services were court ordered.

3  Effective Date.  This act shall take effect 60 days after its passage.

 

LBAO

20-2866

Amended 4/3/20

 

SB 620-FN- FISCAL NOTE

AS AMENDED BY THE SENATE (AMENDMENT #2020-1056s)

 

AN ACT relative to coverage for certain biologically-based mental illnesses.

 

FISCAL IMPACT:      [ X ] State              [ X ] County               [ X ] Local              [    ] None

 

 

 

Estimated Increase / (Decrease)

STATE:

FY 2020

FY 2021

FY 2022

FY 2023

   Appropriation

$0

$0

$0

$0

   Revenue

$0

Indeterminable Increase

Indeterminable Increase

Indeterminable Increase

   Expenditures

$0

Indeterminable Increase

Indeterminable Increase

Indeterminable Increase

Funding Source:

  [ X ] General            [    ] Education            [    ] Highway           [    ] Other

 

 

 

 

 

COUNTY:

 

 

 

 

   Revenue

$0

$0

$0

$0

   Expenditures

$0

Indeterminable

Indeterminable

Indeterminable

 

 

 

 

 

LOCAL:

 

 

 

 

   Revenue

$0

$0

$0

$0

   Expenditures

$0

Indeterminable

Indeterminable

Indeterminable

 

METHODOLOGY:

The Insurance Department indicates this bill requires that coverage for biologically based mental illnesses and substance use disorder treatment service be under the same terms and conditions as physical illnesses.  The bill imposes a number of restrictions on coverage limitations related to treatment for substance use disorders (SUD) including prohibiting prior authorization requirements for prescription drugs approved by the FDA for treatment of SUD, prohibiting step therapy requirements before authorization is provided for such prescription drugs, mandating coverage for all prescription drugs approved by the FDA for SUD treatment, and requiring that all such prescription drugs be covered on the lowest drug formulary tier.  The bill further prohibits exclusions for associated counseling and wraparound services.  The Department assumes prohibitions on coverage limitations may result in coverage expansion and inflationary pressure on claim costs.  This may impact premium rates, and/or coverage purchased, which may impact premium tax revenue.  In addition, the Affordable Care Act requires the State to bear the cost of new mandated coverage for insurance coverage purchased through the Insurance Exchange.  The requirement that issuers cover all prescription drugs approved by the FDA might also be considered an insurance mandate.

 

AGENCIES CONTACTED:

Insurance Department

 

Links

SB620 at GenCourtMobile
SB620 Discussion

Action Dates

Date Body Type
Jan. 22, 2020 Senate Hearing
March 12, 2020 Senate Floor Vote
March 11, 2020 Senate Floor Vote

Bill Text Revisions

SB620 Revision: 8303 Date: April 8, 2020, 11:49 a.m.
SB620 Revision: 7947 Date: Jan. 14, 2020, 12:31 p.m.

Docket

Date Status
Jan. 8, 2020 Introduced 01/08/2020 and Referred to Commerce; SJ 2
Jan. 22, 2020 Hearing: 01/22/2020, Room 100, SH, 01:30 pm; SC 3
March 11, 2020 Committee Report: Ought to Pass with Amendment # 2020-1056s, 03/11/2020; SC 10
March 12, 2020 Committee Report: Ought to Pass with Amendment # 2020-1056s, 03/12/2020; SC 10
March 11, 2020 Committee Amendment # 2020-1056s, AA, VV; 03/11/2020; SJ 6
March 11, 2020 Ought to Pass with Amendment 2020-1056s, MA, VV; OT3rdg; 03/11/2020; SJ 6
June 30, 2020 Introduced and Laid on Table MA VV 06/30/2020 HJ 10 P. 5
Died on Table