Amendment ID: S2769-27

Amendment 27

Ensuring Mental Health Parity

Messrs. Tarr and O'Connor move that the proposed new draft be amended by inserting after SECTION 2 the following new section:-

"SECTION_.Section 8K of chapter 26 of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by adding the following paragraphs:-

As part of its annual review of health insurance carriers’ compliance with state and federal mental health parity provisions, the commissioner of insurance shall require health insurance carriers licensed or authorized to do business under chapters 175, 176A, 176B and 176G to submit utilization reports that document the number of requests, approvals, denials and denial appeals for behavioral health and the number of requests, approvals, denials and denial appeals for non-behavioral health services, and the number of approved out-of-network services for behavioral health services and the number of approved out-of-network services for non-behavioral health services. In creating guidance for these reports, the Division of Insurance shall specify that information be broken down by region and behavioral health service category and shall use this information as part of its evaluation of whether a health carrier’s provider network is adequate to provide access to covered behavioral health services.

The commissioner of insurance shall promulgate regulations to define provider reimbursement parity rules that would apply similar rates of reimbursement to evaluation and management office visits whether the evaluation and management office visits were provided by primary care providers or licensed mental health professionals. Under these rules, the commissioner shall require carriers to establish rates of reimbursement, by geographic region, for evaluation and management office visits by licensed behavioral health providers that are no less than the average rates of reimbursement for evaluation and management office visits by licensed primary care providers in the same geographic region during the prior calendar year. The commissioner shall, at least annually, convene a panel of experts from medical and behavioral health specialties to define the list of office visit codes that will be subject to these rules."