Amendment ID: S2519-13

Amendment 13

Transparency for Mental Health Parity

Mr. Tran moves that the proposed new draft be amended by inserting after section _ the following new section: -

Section XX. Section 13 of Chapter 176O of the General Laws, as appearing in the 2016 Official Edition, is hereby amended by inserting after subsection (d) 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, in addition to all other notices required under this chapter, provide to the insured and to the insured’s authorized representative, if any, 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.