HOUSE BILL NO. 5618

March 12, 2020, Introduced by Reps. Calley, Love, Whiteford and Brann 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) By March 1, 2021, and each March 1 after that date, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall submit a report to the director that includes all of the following information:

(a) For each classification of benefits, identification of all financial requirements and quantitative treatment limitations that are applied to mental health and substance use disorder benefits and medical and surgical benefits, and a description of the process of how the insurer assesses that each financial requirement and quantitative treatment limitation is not more restrictive for mental health and substance use disorder benefits than for the predominant financial requirement or quantitative treatment limitation of that type that is applied to substantially all medical and surgical benefits.

(b) A description of the process used to develop or select the medical necessity criteria for mental health and substance use disorder benefits and the process used to develop or select the medical necessity criteria for medical and surgical benefits.

(c) Identification of all nonquantitative treatment limitations that are applied to both mental health and substance use disorder benefits and medical surgical benefits within each classification of benefits.

(d) The results of an analysis that demonstrates that for the medical necessity criteria described in subdivision (a) and for each nonquantitative treatment limitation identified in subdivision (b), as written and in operation, the processes, strategies, evidentiary standards, or other factors used in applying the medical necessity criteria and each nonquantitative treatment limitation to mental health and substance use disorder benefits within each classification of benefits are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the medical necessity criteria and each nonquantitative treatment limitation to medical and surgical benefits within the corresponding classification of benefits. At a minimum, the results of the analysis under this subdivision must do all of the following:

(i) Identify the factors used to determine that an nonquantitative treatment limitation will apply to a benefit, including factors that were considered but rejected.

(ii) Identify and define the specific evidentiary standards used to define the factors and any other evidence relied on in designing each nonquantitative treatment limitation.

(iii) Provide the comparative analyses, including the results of the analyses, performed to determine that the processes and strategies used to design each nonquantitative treatment limitation, as written, and the as-written processes and strategies used to apply the nonquantitative treatment limitation to mental health and substance use disorder benefits are comparable to, and are applied no more stringently than, the processes and strategies used to design each nonquantitative treatment limitation, as written, and the as-written processes and strategies used to apply the nonquantitative treatment limitation to medical and surgical benefits.

(iv) Provide the comparative analyses, including the results of the analyses, preformed to determine that the processes and strategies used to apply each nonquantitative treatment limitation, in operation, for mental health and substance use disorder benefits are comparable to, and are applied no more stringently than, the processes and strategies used to apply each nonquantitative treatment limitation, in operation, for medical and surgical benefits.

(v) Disclose the specific findings and conclusions reached by the insurer that the results of the analyses under this section indicate that the insurer is in compliance with this section and the Paul Wellstone and Pete Domenici mental health parity and addiction equity act of 2008, subtitle B of title V of division C of Public Law 110-343, and its implementing and related regulations, which include 45 CFR 146.136, 45 CFR 147.160, and 45 CFR 156.115(a)(3).

(2) An insurer described in subsection (1) shall not have any separate nonquantitative treatment limitations that apply to mental health and substance use disorder benefits but do not apply to medical and surgical benefits within any classification of benefits.