The bill seeks to amend current health insurance laws with a focus on mental health and substance use disorder coverage. It prohibits insurance companies from setting rates based on the value of contributions to charitable foundations or from paying rates lower than Medicaid rates for services. Insurance companies must also provide an accounting of their rate cost structure to the commissioner of insurance. The bill ensures that coverage for mental health and substance use disorders is on par with other medical conditions, without annual or lifetime dollar limits, and mandates the use of American Society of Addiction Medicine criteria for substance use disorder treatment coverage. Additionally, it requires equal reimbursement rates for mental health and substance use disorder providers to at least the Medicaid rate schedule.

The legislation also includes provisions for medication-assisted treatment and access to non-opioid pain treatment, such as medically necessary chiropractic care. It stipulates that cost-sharing for behavioral health counseling and medication maintenance visits should be consistent with primary care office visits. The bill explicitly prohibits insurance companies from charging rates that reflect charitable foundation contributions and from paying below Medicaid-approved rates. It mandates that insurance companies submit detailed cost structure accountings for their rates. The act is intended to take effect on January 1, 2025.

Statutes affected:
2726  SUB A: 27-18-54, 27-19-30.1, 27-20-25.2, 27-38.2-1, 27-41-27.2
2726: 27-18-54, 27-19-30.1, 27-20-25.2, 27-41-27.2