Arizona Regulations

The rules provide a process by which plans issued in the state report their compliance with Jake’s Law. Issuers must file reports for each plan they offer, informing the state whether the plans cover MH/SUD benefits, and, if so, whether those benefits are in parity with medical/surgical benefits. Issuers are required to file a report for each plan every three years demonstrating its compliance with NQTL requirements, with an annual report requirement that provides any updates to the last triennial report as well as an attestation by an officer or director of the healthcare insurer that the healthcare plan follows MHPAEA. The new rules also provide an exhibit that lists all the required information for those reports.

In addition, the new rules require healthcare insurers that issue health plans in Arizona and whose policy forms are not exempt from the form filing requirement to demonstrate their compliance with the financial requirements and QTL parity requirements of MHPAEA through their form and rate filings with the Department.

In issuing final approval for a Children’s Health Insurance Program (CHIP) state plan amendment, the Center for Medicare and Medicaid Services (CMS) issued regulatory guidance surrounding mental health parity requirements. CMS guidance provides that child health plans in Arizona are subject to the mental health parity requirements in section 2103(c)(6) of the Social Security Act and section 2705(a) of the Public Health Service Act. Parity laws provide that financial requirements applied to behavioral health benefits in state child health plans should be no more restrictive than those applied to other medical benefits. If the state child health plan provides for delivery of services through a managed care arrangement, this requirement applies to both the state and managed care plans. In addition, the CMS guidance states that CHIP plans covering Early, Periodic Screening, Diagnostic and Treatment (EPSDT) benefits satisfy the mental health parity requirements if the EPSDT benefits are provided in accordance with section 1902(a)(43) of the Social Security Act and fit within the definition of EPSDT benefits as defined by section 1905(r) of the Social Security Act. Among other benefits, Arizona’s state plan amendment provides children with coverage for inpatient and outpatient mental health services including services furnished in a state-operated Medicare certified psychiatric hospital, community-based services, and residential or other 24-hour therapeutically planned structural services. The state plan amendment also provides coverage for outpatient substance abuse treatment disorders under CHIP as well as coverage for case management and care coordination services.

Covered inpatient behavioral health services include all behavioral health services, medical detoxification, accommodations and staffing, supplies, and equipment, if the service is provided under the direction of a physician in a Medicare-certified: (a) General acute care hospital, (b) Inpatient psychiatric unit in a general acute care hospital, or (c) Behavioral health hospital.

Adopted under an exemption from A.R.S. Title 41, Ch. 6, pursuant to Laws 1992, Ch. 301, § 61, effective November 1, 1992; received in the Office of the Secretary of State November 25, 1992 (Supp. 92-4). Amended under an exemption from A.R.S. Title 41, Ch. 6, pursuant to Laws 1992, Ch. 301, § 61, effective September 30, 1993 (Supp. 93-3). Amended under an exemption from A.R.S. Title 41, Ch. 6, pursuant to Laws 1995, Ch. 204, § 11, effective October 1, 1995; filed with the Secretary of State September 29, 1995 (Supp. 95-4). Section repealed, new Section adopted by final rulemaking at 6 A.A.R. 179, effective December 13, 1999 (Supp. 99-4). Amended by exempt rulemaking at 7 A.A.R. 4593, effective October 1, 2001 (Supp. 01-3). Amended by final rulemaking at 11 A.A.R. 5480, effective December 6, 2005 (Supp. 05-4). Amended by final rulemaking at 13 A.A.R. 836, effective May 5, 2007 (Supp. 07-1). Amended by exempt rulemaking at 17 A.A.R. 1870, effective October 1, 2011 (Supp. 11-3). Amended by final rulemaking at 19 A.A.R. 2747, effective October 8, 2013 (Supp. 13-3). Amended by final rulemaking at 20 A.A.R. 3098, effective January 4, 2015 (Supp. 14-4).