Action in the Regulatory Arena
|Primary Focus||Parity: Compliance|
|Agency||Office of the Montana State Auditor, Commissioner of Securities and Insurance|
|Title/Description||2019 Requirements Health Plan Form and Rate Filings Including Qualified Health Plan Certification|
|Citation||Montana Insurance Notices and Bulletins April 2, 2018|
The bulletin provides instructions for on and off-exchange health plans. These instructions, including the timeline, apply to individual and small employer group health insurance. The Commissioner of Securities and Insurance is the primary regulator for all health insurance products sold in Montana. Policies may not exclude the services of specific types of providers that are acting within the scope of their license and providing a service that is a covered benefit, including, but not limited to, licensed marriage and family therapists and licensed addiction counselors. This practice may violate section 2706 of the ACA, as well as Mont. Code Ann. 33-22-111 and 33-30-1019. Broad exclusions for “family therapy,” “play therapy” and “group therapy” may be disapproved. Those services must be reviewed under medical necessity requirements that respect the parameters of the Mental Health Parity and Addiction Equity Act.
The Montana Commissioner of Securities and Insurance released a bulletin (pdf | Get Adobe® Reader®) on mental health parity, focusing on non-quantitative treatment limitations. The memorandum contains a examples of “red flags” that indicate a potential parity violation. All of the “red flags” are taken from de-identified consumer complaints to the department. Examples include the following:
- All outpatient mental health therapy must be justified with a new treatment plan every 90 days
- All in-patient stays for mental illness or substance use disorder must be reauthorized every 5 days
- No out-of-state treatment options for mental illness or substance use disorders
- Inadequate network of mental health providers
- Denial of claims or refusal of prior authorization for mental health treatment
- Refusal to continue payment for outpatient therapy because progress has not been “proven” by the provider
- Refusal to pay for therapy relating to a co-occurring mental illness while a member is receiving treatment for a substance use disorder
- Refusal to pay for higher cost therapies until patient fails at a lower cost treatment
- Exclusion of coverage for certain types of treatment without any medical necessity analysis
The Montana Commissioner of Securities and Insurance released a bulletin (pdf | Get Adobe® Reader®) on 2017 requirements for health plan form filing. Among other things, the document contains a section on exclusions relating to transgendered individuals. The document clarifies that all exclusions relating to transgendered individuals must be removed. This is partly because of a Montana statute that prohibits discrimination against individuals in the same class. According to this statute, transgendered individuals are considered in the same class as non-transgendered individuals who may have a mental health condition.
Christina Goe, General Counsel to the Montana Commissioner of Securities and Insurance, presented on the Montana Medicaid Expansion. The presentation had three slides on parity. The slides contain information on consumer protections under the Federal Parity Law. This presentation is similar to Goe’s 11/2014 presentation.
Christina Goe, General Counsel to the Montana Commissioner of Securities and Insurance, presented on the Montana Medicaid Expansion. The presentation had three slides on parity. The slides contain information on consumer protections under the Federal Parity Law. This presentation is similar to Goe’s 10/2014 presentation.
Christina Goe, General Counsel to the Montana Commissioner of Securities and Insurance, presented on health care reform in Montana. The presentation has two slides on the Federal Parity Law. The first slides states that health insurers can not apply financial requirements and treatment limitations in a more restrictive manner for mental health/substance use disorder benefits than physical health benefits. The second slide defines which plans must comply with the Federal Parity Law.
The Montana Commissioner of Securities and Insurance took action against Assurant Health in Montana. Among other things, the company was not offering coverage for “severe mental illness” as is required by Montana’s insurance law. Assurant Health agreed to pay $39,569.76 in unpaid claims and to pay a $225,000 fine.
The Montana Commissioner of Securities and Insurance issued a bulletin (pdf | Get Adobe® Reader®) notifying insurance plans about the requirements of the section of state law about autism coverage. The bulletin went into specific detail about what treatments must be covered, the annual maximums in place, the language in the law about financial requirements, that the law does apply to several types of plans beyond large employer fully-insured plans and small employer fully-insured plans, and that coverage for individuals with autism older than age 18 should be “no less favorable” than coverage for other medical conditions.
|Primary Focus||Access to Services|
|Agency||Public Health and Human Services|
|Title/Description||Cost Sharing Provisions|
|Summary||Outlines co-pays for Healthy Montana Kids enrollees when parents/guardians meet family income requirements. Co-pays for behavioral health services are less than or equal to physical health services.|