Indiana Statutes

HB 1092 .  For full text, click here.  Will amend IC §§ 12-15-5-17, 12-15-13-9, 27-8-5-15.8 and IC 27-13-7-14.2.

Highlights include the following:

• Provider Coverage Requirements. Expands MH providers under the state’s Medicaid program (with a few limitations) to cover licensed clinical social workers, licensed mental health counselors, licensed clinical addiction counselors and licensed marriage and family therapists.
• Parity Compliance and Reporting Requirements. Implements key parity compliance requirements for both group and individual coverage licensed by the state.  Insurers are to submit an annual report to the Department of Insurance covering items such as:
  • MH/SUD and medical/surgical medical necessity criteria.
  • MH/SUD and medical/surgical nonquantitative treatment limitations (NQTLs) within each designated benefit classification.
  • Identification and definitions of the specific evidentiary standards used to define the factors and any other evidence relied upon in designing each NQTL.
  • Comparative analyses used to design and implement the processes and strategies used to apply each MH/SUD NQTL, which shall be applied no more stringently than the processes and strategies used for medical/surgical NQTLs.
• State Reporting Requirements. No later than the spring of 2021, the Department of Insurance shall submit a report to the general assembly concerning its implementation of rules and procedures to ensure compliance.  The electronic-based report shall include:
  • The methodology the Department uses to determine insurers’ compliance with the act.
  • The results of the target market conduct examinations conducted or completed to determine insurers’ compliance with state and federal laws regarding parity in coverage of services for treatment of a mental illness or substance abuse in the past twelve (12) months.
  • Any educational or corrective action the Department has taken to ensure insurers’ compliance with the act.

July 1, 2020.
Notes:   This new state parity law provides key aspects included in a Model State Parity Legislation developed by The Kennedy Forum and several other consumer advocacy groups.  Some aspects of this new law sunsets on June 30, 2021.

This law requires state authorities to amend state Medicaid plans to include reimbursement for the treatment of outpatient mental health and substance abuse treatment services. It also requires health maintenance organizations and insurers to submit annual reports demonstrating compliance with the 2008 Mental Health Parity and Addiction Equity Act, including an analysis for each non-quantitative treatment limitation in each classification of care consistent with the six-step process.

Section 12-15-5-14 was added to the Indiana Code to require the Medicaid office to reimburse eligible Medicaid claims for services provided by an advanced practice nurse employed by a community mental health center if the services are part of the advance practice nurse’s scope of practice, including mental health services, behavioral health services, substance use treatment and evaluation and management services for inpatient or outpatient psychiatric treatment.

Amended by In. H. 1347.

• Provider has a waiver from the federal Substance Abuse and Mental Health Services Administration and meet the qualifying standards to treat opioid addicted patients in an office based setting
• Provider has a valid federal drug enforcement administration registration number and a drug enforcement administration identification number that specifically authorizes treatment in an office based setting

The bill also defines the following requirements for an opioid treatment program. The program must provide treatment for opioid addiction using a drug approved by the federal Food an Drug Administration for opioid addiction. The program must also be an enrolled Medicaid Provider under Indiana state law, an enrolled Health Indiana Plan Provider, or a provider credentialed to accept insurance from a health plan.

 This bill amends the state Medicaid law about the Healthy Indiana Plan (HIP). The bill requires that HIP cover mental health and substance use disorder services. It also states that the plan can not use treatment limitations or financial requirements for mental health or substance use disorders if there are no similar limitations or requirements for medical or surgical conditions.

Burns Ind. Code Ann §§ 16-18-2-348.5, 27-8-34, 27-13-1-34

Section 16-18-2-348.5 was added to the Indiana Code to provide a definition for telemedicine, which, for the purposes of IC 16-36-1, means a specific method of delivery of services, including medical exams and consultations and behavioral health evaluations and treatment, including those for substance use, using videoconferencing equipment to allow a provider to render an examination of other services to a patient at a distant location. Sections IC 27-8-34 and IC 27-13-1-34 were also added to the Indiana Code to provide coverage for telemedicine services, which includes behavioral health, including substance abuse evaluations and treatment.

Amended by IN H. 1269.

Burns Ind. Code Ann. §§ 11-12-3.8-1.5, 12-15-5-13, 12-15-35.5-7.5, 27-8-32.4, 27-13-7-20.4

Section 11-12-3.8-1.5 was added to the Indiana Code to allow for substance abuse treatment to include addiction counseling, inpatient detoxification and medication assisted treatment, including federal FDA approved long acting, nonaddictive medication for the treatment of opioid or alcohol dependence. Section 12-15-5-13 was also added to the Indiana Code to require the Medicaid office to provide for treatment of opioid or alcohol dependence that includes counseling services that address the psychological and behavioral aspects of addiction; when medically indicated, drug treatment involving agents proved by the federal FDA for the treatment of opioid or alcohol dependence or prevention of relapse to opioids or alcohol after detoxification. The Medicaid office shall also develop quality measures to ensure and requires a Medicaid managed care organization to report compliance with the coverage required. Section 12-15-35.5-7.5 was added to the Indiana Code to allow the office or a managed care organization to reimburse under Medicaid for methadone if the drug was prescribed for the treatment of pain or pain management only as follows: (1) If the daily dosage is not more than sixty (60) milligrams. (2) If the daily dosage is more than sixty (60) milligrams, only if: (A) prior authorization is obtained; and (B) a determination of medical necessity has been shown. Lastly, Section 27-8-32.4 and Section 27-13-7-20.4 were also added regarding the coverage of methadone by policies of accident and sickness insurance policies and individual contractor group contract policies that are issued, amended or renewed after June 30, 2015, provided that it prescribed for the treatment of pain or pain management (1) If the daily dosage is not more than sixty (60) milligrams. (2) If the daily dosage is more than sixty (60) milligrams, only if: (A) prior authorization is obtained; and (B) a determination of medical necessity has been shown by the provider.

Amended by In. S. 464.

• Inpatient care
• Residential treatment
• Community mental health rehabilitation services
• Outpatient care