Definition


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Legislation Signed into Law

2020

Primary Focus Implementing key aspects of the Federal Parity Law at the state level.
Title/Description Mental health and substance use disorder parity compliance and reporting law
Citation

SB 1718 . For full text, click here. Amends 2018 Oklahoma Statute Title 36. Insurance
§§36-6060.10-6060.13.

Summary

Highlights include:

  • Parity Compliance Requirements. Requires state to implement and enforce the Federal Parity Law provisions for group and individual insurance policies and other arrangements such as multiple employer welfare arrangements.
  • Definitions. Defines “mental health and substance use disorder” pursuant to the diagnostic categories in the most recent editions of the ICD or DSM manuals.
  • Parity Compliance and Reporting Requirements. Mandates that covered insurers submit an annual report to the state insurance department on or before April each year that contains the following:
    • 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 showcasing both in writing and in operation 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
    • Results of the analyses using the six steps approach.
    • Disclosure of the specific findings and conclusions reached based on the comparative analysis.
  • Enforcement and Transparency. Charges the state insurance commissioner to enforce the new parity law and shall:
    • Republish the annual insurer parity compliance reports (without confidential information) on or before June 1 each year (starting in 2021).
    • Identify insurers that have failed in whole or part to comply on the insurance. departments website which shall include a public list of non-complying insurers.
    • Requires the insurance department to publish additional regulations regarding the new state parity law.
    • Expands insurance department’s requirements to collect, analyze and report on insurer premium increases, claims filed, utilization of services and actuarial assumptions used to offer and provide “mental health” (formerly just severe mental illness) and “substance use disorders” (required for the first time) services.
  • Premium Rate Increases. Creates indirectly an insurance cap on premium increases for the provision of MH/SUD services.
Effective Date

November 1, 2020.
Notes:   This new state parity law is based on a framework similar to the Model State Parity Legislation developed by The Kennedy Forum and several other consumer advocacy groups.

Primary Focus Compliance; Reporting
Title/Description An Act relating to health insurance
Citation O.S. §§ 6060-10 — 6060-13
Summary

This law requires all in-state health plans to comply with the 2008 federal Mental Health Parity and Addiction Equity Act. Specific provisions include removing exclusion of small employers from the requirement to provide mental health/substance use disorder benefits, and prohibiting health benefit plans from imposing stricter non-quantitative limitations on mental health and substance use disorder benefits than physical benefits. The law also requires insurance companies that offer mental health or substance use disorder plans 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.  Reporting will begin April 1, 2021 and the department will make reports public starting June 1, 2021. The bill also clarifies mental health and substance use disorders to refer to all conditions listed under appropriate diagnostic guides, expanding the definition beyond the previously used “serious mental illness.”

Effective Date 11/1/20

2015-2016

Primary Focus Mandated Benefit: Provider
Title/Description Coverage of Autism Spectrum Disorders
Citation Okla. Stat. 36 § 6060.21
Summary

A health benefit plan and the Oklahoma Employees Health Insurance Plan must provide coverage for the screening, diagnosis and treatment of autism spectrum disorder in individuals less than nine (9) years of age, or if an individual is not diagnosed or treated until after three (3) years of age, coverage shall be provided for at least six (6) years, provided that the individual continually and consistently shows sufficient progress and improvement as determined by the health care provider. Additionally, no insurer can terminate coverage, or refuse to deliver, execute, issue, amend, adjust or renew coverage to an individual solely because the individual is diagnosed with or has received treatment for an autism spectrum disorder.

Effective Date 11/1/2016
Notes

Enacted by OK. HB 2962.

2009-2010

Primary Focus Mandated Benefit: Provider & Parity
Title/Description Insurance Plans to Include Treatment of Severe Mental Illness
Citation Okla. Stat. 36 § 6060.11
Summary

Any health benefit plan that is offered, issued, or renewed on or after the effective date of this act shall provide benefits for treatment of severe mental illness. Treatment limitations applicable to mental health or substance abuse disorder benefits shall be no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the plan. There shall be no separate treatment limitations that are applicable only with respect to mental health or substance abuse disorder benefits.

Effective Date 5/10/2010
Notes Amended by OK. SB 2054

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Common Violations

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