Amendment ID: S2020-4

Amendment 4

Safeguarding Parity Rights

Messrs. Joyce and Montigny and Mrs. L'Italien move to amend the bill by inserting after section 38 the following 3 sections:-

SECTION 39A. Section 17 of chapter 176O of the General Laws, as amended by section 72 of chapter 35 of the acts of 2013, is hereby further amended by inserting after the word “inclusive”, in line 2, the following words:- “, and 24A”.

SECTION 39B. Subsection (b) of section 24 of said chapter 176O, as appearing in the 2012 Official Edition, is hereby amended by adding the following sentence:- The decision on the appeal shall prominently provide information on the patient’s right to appeal the decision to the office of patient protection including, but not limited to: (A) contact information for the office of patient protection,; (B) a notice of a patient’s right to file a grievance with the office of patient protection; and (C) information on how to file a grievance with the office of patient protection.

SECTION 39C. Said chapter 176O is hereby further amended by inserting after section 24 the following section:-

Section 24A. The office of patient protection shall report overturned or partially overturned behavioral health care denials to the division of insurance; provided, however, that the office shall only share patient information received by the office under the external review process established in subsection (d) of section 24 if the patient or the patient’s guardian has consented to sharing patient information with the division. The division shall review each reported denial to determine whether the denial constitutes a violation of the federal Mental Health Parity and Addiction Equity Act of 2008, § 511 of Public Law 110-343, and applicable state mental health parity laws including, but not limited to: section 22 of chapter 32A; section 47B of chapter 175; section 8A of chapter 176A; section 4A of chapter 176B; and sections 4, 4B and 4M of chapter 176G.

If the division finds evidence that a violation has occurred including, but not limited to, a determination by the office to overturn a health care denial in full or in part, the division shall investigate pursuant to its powers under section 8K of chapter 26.

If the division finds that a violation of the mental health and substance abuse parity laws has occurred, the division shall levy a fine of not less than $25,000 per violation; provided, however, that the division shall levy an additional fine of not less than $100,000 per occurrence if an insurer demonstrates a clear pattern or practice of violating the mental health and substance abuse parity laws.

The division shall promulgate regulations to ensure the protection of patients’ information in the division’s custody that shall comply with 42 U.S.C. § 290dd-2, 42 C.F.R. Part 2 and 45 C.F.R. § 164.512.

The division shall post a public notice on the division’s public website if the division finds a violation of mental health parity laws.

The office shall post statistics regarding behavioral health reviews on its public website that shall be organized by insurer and plan type.