SENATE DOCKET, NO. 506        FILED ON: 1/15/2015

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 512

The Commonwealth of Massachusetts

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PRESENTED BY:

John F. Keenan

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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act relative to transparency for mental health parity.

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PETITION OF:

SENATE DOCKET, NO. 506        FILED ON: 1/15/2015

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 512

The Commonwealth of Massachusetts

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In the One Hundred and Eighty-Ninth General Court
(2015-2016)

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An Act relative to transparency for mental health parity.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. Section 13 of chapter 176O of the General Laws, as appearing in the 2012 Official Edition, is hereby amended by adding at the end thereof the following subsection:-

(e) for any grievance involving a denial of coverage for mental health services, including behavioral health and substance abuse disorder services, the carrier shall provide to the insured, and to the insured’s authorized representative if any, in addition to all other notices required under this chapter, a statement certifying and specifically describing the following:

(i) That the denial of coverage by carrier, or the carrier’s utilization review organization or other subcontracted entity, is in compliance with applicable state parity requirements for providing coverage on a  nondiscriminatory basis as defined in Chapter 80 of the Acts of 2000;

(ii) The quantitative and non-quantitative treatment limitations applied during review, and how said limitation criteria comply with state and federal parity regulations, including those codified at 42 U.S. Code § 300gg–26, and regulations implemented pursuant to section 8K of chapter 26 of the General Laws; and

(iii) A certification that the carrier’s claim processing and utilization review methods complied with the above parity requirements.