Primary Focus: Medical Management Limitations; Mandated benefit: Other; Enforcement: Reporting Requirement
Title/Description: Omnibus Health and Human Services appropriation bill
Citation: Minnesota Statutes 2018, section 62Q
Summary: The bill prohibits individual and group health insurance policies from applying NQTLs on MH/SUD benefits that are not also equitably applied to med/surgical benefits. Additionally, the bill requires mental health therapy visits and medication maintenance visits to be considered primary care visits for the purpose of cost-sharing requirements. The bill also requires the Commissioner of Commerce with the Commissioner of Health to submit a report to the legislature detailing parity overview and enforcement activities. Such report must be written in nontechnical, readily understandable language and must be made available to the public
Effective Date: January 1, 2020; July 1, 2019
Primary Focus: Mandated Benefit: Early Intensive Developmental and Behavioral Intervention (Autism Spectrum Disorder)
Title/Description: Early Intensive Developmental and Behavioral Intervention Benefit
Citation: Minn. Stat. § 256B.0949
Summary: Authorizes the early intensive developmental and behavioral intervention (EIDBI) benefit to provide early intensive intervention to a person with an autism spectrum disorder or a related condition. This benefit must provide coverage for a comprehensive, multidisciplinary evaluation, ongoing progress monitoring, and medically necessary early intensive treatment of autism spectrum disorder or a related condition. Nothing in this section shall preclude coverage for other medical assistance benefits based on a person’s diagnosis of an autism spectrum disorder or a related condition, including, but not limited to, coverage under section 256B.0943 of children’s therapeutic services and supports.
Effective Date: August 1, 2018
Notes: Enacted by 2013 Minn. H.F. No. 1233; most recently amended by Minn. S.F. No. 3326.
Primary Focus: Mandated Benefit: Coverage for Autism Spectrum Disorder
Title/Description: Coverage for Autism Spectrum Disorder
Citation: Minn. Stat. § 62A.3094
(a) A health plan issued to a large employer, as defined in section 62Q.18, subdivision 1, must provide coverage for the diagnosis, evaluation, multidisciplinary assessment, and medically necessary care of children under 18 with autism spectrum disorders, including but not limited to the following:
(1) early intensive behavioral and developmental therapy based in behavioral and developmental science, including, but not limited to, all types of applied behavior analysis, intensive early intervention behavior therapy, and intensive behavior intervention;
(2) neurodevelopmental and behavioral health treatments and management;
(3) speech therapy;
(4) occupational therapy;
(5) physical therapy; and
Effective Date: January 1, 2015
Notes: Enacted by Minn. H.F. No. 1233.
Primary Focus: Mandated Benefit: Mental Health and Substance Use Disorder Services
Title/Description: Essential Health Benefit Package Requirements
Citation: Minn. Stat. § 62Q.81
Summary: Subdivision 1. Essential health benefits package.
(a) Health plan companies offering individual and small group health plans must include the essential health benefits package required under section 1302(a) of the Affordable Care Act and as described in this subdivision.
(b) The essential health benefits package means coverage that:
(1) provides essential health benefits as outlined in the Affordable Care Act;
(2) limits cost-sharing for such coverage in accordance with the Affordable Care Act, as described in subdivision 2; and
(3) subject to subdivision 3, provides bronze, silver, gold, or platinum level of coverage in accordance with the Affordable Care Act.
Subd. 4. Essential health benefits; definition. — For purposes of this section, “essential health benefits” has the meaning given under section 1302(b) of the Affordable Care Act and includes:
. . . (6) mental health and substance use disorder services, including behavioral health treatment;
Effective Date: January 1, 2014
Notes: Enacted by Minn. H.F. No. 779.
Primary Focus: Parity: General
Title/Description: Alcoholism, Mental Health, and Chemical Dependency Services
Citation: Minn. Stat. § 62Q.47
Summary: All health plans must meet the requirements of the federal Mental Health Parity Act of 1996, Public Law 104-204; Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; the Affordable Care Act; and any amendments to, and federal guidance or regulations issued under, those acts.
Effective Date: May 24, 2013
Notes: Enacted by Minn. H.F. No. 779.
Primary Focus: Mandated Benefit: Court-Order Mental Health Coverage
Title/Description: Coverage for Court-Ordered Mental Health Services
Citation: Minn. Stat. § 62Q.535
Summary: All health plan companies that provide coverage for mental health services must cover or provide mental health services ordered by a court of competent jurisdiction under a court order that is issued on the basis of a behavioral care evaluation performed by a licensed psychiatrist or a doctoral level licensed psychologist, which includes a diagnosis and an individual treatment plan for care in the most appropriate, least restrictive environment.
Effective Date: July 1, 2002
Notes: Enacted by Minn. H.F. No. 3163.
Minnesota state insurance law has several sections about coverage for behavioral health conditions. Minnesota’s law is not a comprehensive parity law because it does require insurance plans to provide behavioral health coverage. It only applies to plans that do offer behavioral health coverage.
Chapter 62Q Section 47 of the state insurance law says that insurance plans cannot place a “greater financial burden” on consumers for inpatient and outpatient behavioral health services than what is in place for other medical services. Plans also cannot have treatment limitations for inpatient and outpatient behavioral health services that are “more restrictive” than limitations used for other medical services. This section of the law also says that all plans have to meet the requirements of the Federal Parity Law and the Affordable Care Act .
Chapter 62Q Section 53 of the state insurance law defines medically necessary care for mental health treatment and says that insurance plans cannot use a more restrictive definition. The law specifies that “health care services appropriate, in terms of type, frequency, level, setting, and duration, to the enrollee’s diagnosis or condition, and diagnostic testing and preventive services. Medically necessary care must be consistent with generally accepted practice parameters as determined by health care providers in the same or similar general specialty as typically manages the condition, procedure, or treatment at issue and must:
Chapter 62A Section 3094 requires large employer fully-insured plans to cover services for autism for children under age 18. The law defines autism spectrum disorders as any conditions classified as such in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The law states that insurance plans must cover “medically necessary care.” In the law, medically necessary care “must be consistent with generally accepted practice parameters as determined by physicians and licensed psychologists who typically manage patients who have autism spectrum disorders.”
The law specifically requires insurance plans to cover all of the following:
Coverage must also include anything that is part of an individualized treatment plans prescribed for the child by his or her physician or mental health professional.
Insurance plans are allowed to request an updated treatment plan no more often than once every six months. However insurance plans are allowed to have an independent professional with training in autism spectrum disorder and child development perform an evaluation to determine if the patient is making progress under the treatment plan. There is no language explaining what plans can or cannot do if it is determined that the child is not progressing.
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