Bill Summary – FastDemocracy

H.B. 653
                          GENERAL ASSEMBLY OF NORTH CAROLINA
                                                                                            Apr 22, 2021
                                      SESSION 2021                                    HOUSE PRINCIPAL CLERK
     H                                                                                               D
                                  HOUSE BILL DRH30284-MR-21A
     Short Title:   Mental Health & SUD Parity Report.                                         (Public)
     Sponsors:      Representative Cunningham.
     Referred to:
                                    A BILL TO BE ENTITLED
 AN ACT TO REQUIRE INSURERS OFFERING A HEALTH BENEFIT PLAN IN THIS
     STATE TO SUBMIT AN ANNUAL MENTAL HEALTH AND SUBSTANCE USE
     DISORDER PARITY REPORT TO THE COMMISSIONER OF THE DEPARTMENT OF
     INSURANCE AND THE JOINT LEGISLATIVE OVERSIGHT COMMITTEE ON
     HEALTH AND HUMAN SERVICES BEGINNING MARCH 1, 2022.
 The General Assembly of North Carolina enacts:
             SECTION 1. Article 3 of Chapter 58 of the General Statutes is amended by adding
 a new section to read:
 "§ 58-3-220.1. Mental health and substance use disorder parity report.
     (a)     No later than March 1 of each year, each insurer offering a health benefit plan in this
 State shall submit to the Commissioner and to the Joint Legislative Oversight Committee on
 Health and Human Services a report detailing the insurer's compliance with federal and State
 mental health and substance use disorder parity laws using data from the two calendar years
 preceding the date of submission of the report and accounting for each health benefit plan offered
 by that insurer.
     (b)     Reports required under this section shall contain all of the following information:
             (1)    Rates of utilization review for mental health and substance use disorder claims
                    compared to medical and surgical claims, including rates of approval and
                    denial, categorized by benefits provided under the following classifications:
                    a.       Inpatient in-network.
                    b.       Inpatient out-of-network.
                    c.       Outpatient in-network.
                    d.       Outpatient out-of-network.
                    e.       Emergency care.
                    f.       Prescription drugs.
             (2)    The number of prior or concurrent authorization requests for mental health
                    and substance use disorder services and the number of denials for those
                    requests, compared with the number of prior or concurrent authorization
                    requests for medical and surgical services and the number of denials for those
                    requests, categorized by the same classifications identified in subdivision (1)
                    of this subsection.
             (3)    The rates of appeals of adverse determinations, including the rates of adverse
                    determinations upheld and overturned, for mental health and substance use
                    disorder claims compared with the rates of appeals of adverse determinations,
                                  *DRH30284-MR-21A*
     General Assembly Of North Carolina                                                    Session 2021
                     including the rates of adverse determinations upheld and overturned, for
                     medical and surgical claims.
             (4)     The percentage of claims paid for in-network mental health and substance use
                     disorder services compared with the percentage of claims paid for in-network
                     medical and surgical services.
             (5)     The percentage of claims paid for out-of-network mental health and substance
                     use disorder services compared with the percentage of claims paid for
                     out-of-network medical and surgical services.
             (6)     A comparison of the cost-sharing requirements, including copayments and
                     coinsurance, and the benefit limitations, including limitations on the scope and
                     duration of coverage, for mental health and substance use disorder services
                     with the same cost-sharing requirements and benefit limitations for medical
                     and surgical services.
             (7)     The number, by type, of in-network providers that provide services for the
                     treatment and diagnosis of substance use disorder and the number, by type, of
                     in-network providers that provide services for the diagnosis and treatment of
                     mental health disorders, however defined by the health benefit plan.
                     Additionally, of the number of in-network providers, the percentage who are
                     licensed to practice in this State and who are licensed to practice in contiguous
                     states.
             (8)     Any other data, information, or metric the Commissioner determines is
                     necessary to measure compliance with mental health and substance use
                     disorder parity laws. The Commissioner may not require the disclosure of any
                     privileged or confidential information, trade secret, or protected health
                     information.
     (c)     No later than July 1 of each year, the Commissioner shall publish on the Department's
 website all reports submitted under this section for that calendar year.
     (d)     No information submitted by an insurer shall disclose any protected health
 information of an insured."
             SECTION 2. This act becomes effective January 1, 2022.
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