Budget Amendment ID: FY2015-S4-772-R1

Redraft EHS 772

Transparency for Mental Health Parity I

Messrs. Keenan and Donnelly, Ms. Forry, Messrs. Joyce, Pacheco and Michael O. Moore moved that the proposed new text be amended moved that the bill be amended by inserting after section __the following new section:-

SECTION __. 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 carrier, or the carrier’s utilization review organization or other subcontracted entity, denied coverage in compliance with applicable state parity requirements for providing coverage on a  nondiscriminatory basis as defined at 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.