Primary Focus: Reporting Agency: Department of Health Title/Description: Health Care Group Purchaser Reporting Citation:Minn. R. 4652.0100 Summary: MENTAL HEALTH SERVICES EXPENSES. “Mental health services expenses” means all costs related to inpatient and outpatient mental health services that are coded using one or more of the following codes or amended equivalent codes:
ICD-9 diagnosis code ranges 290 to 302.9 and 306 to 319; and
CPT codes: 90801, 90841, 90843, 90844, 90844.22, 90846, 90847, 90847.22, 90849, 90853, 98900, 98902, 98910, and 98912.Mental health services expenses also means all costs related to inpatient and outpatient mental health services that are coded using codes from another coding system where the commissioner determines that the codes indicate diagnoses or procedures comparable to or consistent with codes listed in items A and B. A group purchaser may use a nationally recognized standardized reporting system to capture costs for mental health inpatient, outpatient, and other professional services. Mental health services expenses does not include prescription drugs or supplies administered or dispensed which are billed directly through a hospital or health care provider.
Effective Date: 1997; amended on September 12, 2016 Notes: N/A
The Minnesota Insurance Division released a press release notifying consumers that they have a right to appeal for an insurance company’s denial of coverage for medical treatment. While this notice is not specific to behavioral health care denials, parity violations are frequently present in care denials.
The Minnesota Insurance Division issued a checklist(pdf | Get Adobe® Reader®) guide for use by its own employees in seeing if health insurance plans comply with the state insurance law when they review plans for approval. The checklist includes sections of the law related to parity within state law. Next to each section of the law are columns of different types of insurance plans. If there is an x in the column, the plan has to comply with that particular law. If the column is blacked out, the plan does not have to comply with that section of the law.
Primary Focus: Medicaid Agency: Department of Human Services Title/Description: MinnesotaCare: Covered Health Services Citation:Minn. R. 9506.0080 Summary: 2. INPATIENT HOSPITAL SERVICES.
Enrollees are covered for medically necessary inpatient hospital services including acute care services, mental health services, and chemical dependency services.
Effective Date: January 14, 2010 Notes: Minn. R. 9506.0080 was enacted from final rulemaking at 19 SR 1286.
Primary Focus: Medicaid Agency: Department of Human Services Title/Description: MinnesotaCare: Other Managed Care Health Plan Obligations Citation:Minn. R. 9506.0400 Summary:
SECOND MEDICAL OPINION. A health plan must include in its certificate of coverage information about enrollees’ right to a second medical opinion according to items A to C.
Upon enrollee request, the health plan shall provide at health plan expense a second medical opinion by a participating provider within the health plan.
The health plan shall comply with Minnesota Statutes, section 62D.103, and shall provide at health plan expense a second medical opinion by a qualified nonparticipating provider when the health plan determines that an enrollee’s chemical dependency or mental health problem does not require structured treatment.
The health plan shall provide at health plan expense a second medical opinion when ordered to do so by a state human services referee under Minnesota Statutes, section 256.045.
Effective Date: January 14, 2010 Notes: Minn. R. 9506.0400 was enacted from final rulemaking at 20 SR 495; L 1997 c 225 art 2 s 62; L 2002 c 277 s 32.
Minnesota Parity Law
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 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:
Help restore or maintain the enrollee’s health; or
Prevent deterioration of the enrollee’s condition.
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:
All types of applied behavior analysis, intensive early intervention behavior therapy, and intensive behavior intervention
Neurodevelopmental and behavioral health treatments and management
Coverage must also include anything that is part of 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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