Definition


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This page lists some of the action toward parity compliance undertaken by state regulatory agencies since 2008.

Are we missing any actions taken by state regulatory agencies? Let us know at info@paritytrack.org

Actions in the Regulatory Arena

09/2016

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:

  1. ICD-9 diagnosis code ranges 290 to 302.9 and 306 to 319; and
  2. 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 9/12/2016

11/2015

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.

02/2014

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.

01/2010

Primary Focus Medicaid
Agency Department of Human Services
Title/Description MinnesotaCare: Covered Health Services
Citation Minn. R. 9506.0080
Summary

2. INPATIENT HOSPITAL SERVICES.

  1. Enrollees are covered for medically necessary inpatient hospital services including acute care services, mental health services, and chemical dependency services.
Effective Date 1/14/2010
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
  1. 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.
  2. Upon enrollee request, the health plan shall provide at health plan expense a second medical opinion by a participating provider within the health plan.
  3. 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.
  4. 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 1/14/2010
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.

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Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.