HOUSE BILL NO. 5619

March 12, 2020, Introduced by Reps. Brann, Calley and Love and referred to the Committee on Health Policy.

"The insurance code of 1956,"

(MCL 500.100 to 500.8302) by adding section 3406v.

the people of the state of michigan enact:

Sec. 3406v. (1) The director shall implement and enforce applicable provisions of the Paul Wellstone and Pete Domenici mental health parity and addiction equity act of 2008 and federal guidance or regulations relevant to, that act, including 45 CFR 146.136, 45 CFR 147.136, 45 CFR 147.160, and 45 CFR 156.115(a)(3), which include all of the following:

(a) Proactively ensuring compliance by any insurer that delivers, issues for delivery, or renews in this state a health insurance policy.

(b) Evaluating all consumer or provider complaints regarding mental health and substance use disorder coverage for possible parity violation.

(c) Performing parity-compliance market conduct examinations of insurers, particularly market conduct examinations that focus on nonquantitative treatment limitations such as prior authorization, concurrent review, retrospective review, step therapy, network admission standards, reimbursement rates, and geographic restrictions, among other nonquantitative treatment limitations.

(d) Requiring that insurers submit comparative analyses during the form review process demonstrating how they design and apply nonquantitative treatment limitations, both as written and in operation, for mental health and substance use disorder benefits as compared to how they design and apply nonquantitative treatment limitations, as written and in operation, for medical and surgical benefits.

(2) By April 1, 2020, and each April 1 after that date, the director shall issue a report and educational presentation to the legislature, that must do all of the following:

(a) Cover the methodology the director is using to check for compliance with the Paul Wellstone and Pete Domenici mental health parity and addiction equity act of 2008, and any federal regulations or guidance relating to the compliance and oversight of the Paul Wellstone and Pete Domenici mental health parity and addiction equity act of 2008.

(b) Cover the methodology the director is using to check for compliance with section 3425 and section 414a of the nonprofit health care corporation reform act, 1980 PA 350, MCL 550.1414a.

(c) Identify market conduct examinations conducted or completed during the preceding 12-month period regarding compliance with parity in mental health and substance use disorder benefits under state and federal laws and summarize the results of the market conduct examinations.

(d) Detail any educational or corrective actions the director has taken to ensure insurer compliance with the Paul Wellstone and Pete Domenici mental health parity and addiction equity act of 2008 and section 3425 and section 414a of the nonprofit health care corporation reform act, 1980 PA 350, MCL 550.1414a.

(e) Be written in nontechnical, readily understandable language and made available to the public by, among other means as the director finds appropriate, posting the report on the department's website.

(3) The director, in collaboration and consultation with the director of the department of health and human services, must appoint a workgroup to assist the director in planning and implementing a statewide consumer educational campaign on behavioral health parity, that must include a focus on behavioral health parity in the state's medical assistance program, to be conducted in 2021. The campaign must, at a minimum, provide public trainings in each of the state's prepaid inpatient health plan regions as well as a consumer hotline to assist individuals in navigating the parity process. The workgroup shall report to the legislature on the implementation and outcomes of the educational campaign by July 1, 2022. The workgroup appointed under this subsection consists of the following members appointed by the director:

(a) Three members representing nonprofit behavioral health advocacy agencies, at least 1 of which must be an organization with focus on children and youth.

(b) Two members who have received behavioral health services.

(d) Two members representing providers of behavioral health service, at least 1 of whom has experience with Medicaid services.

(e) One member representing the department of health and human services.

(f) One member representing health insurers.

(g) One member representing Medicaid managed care organizations, which may include someone representing a specialty prepaid health plan.

(4) As used in this section, "the Paul Wellstone and Pete Domenici mental health parity and addiction equity act of 2008" means subtitle B of title V of division C of Public Law 110-343.