This document includes House Committee Amendments incorporated into the bill on Thu, Feb 24, 2022 at 11:23 AM by pflowers.
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MENTAL HEALTH TREATMENT AMENDMENTS

2     
2022 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Brian S. King

5     
Senate Sponsor: Jacob L. Anderegg

6     

7     LONG TITLE
8     General Description:
9          This bill modifies the Accident and Health Insurance provisions of the Insurance Code
10     to address mental health coverage requirements for health plans offered by certain
11     governmental entities.
12     Highlighted Provisions:
13          This bill:
14          ▸     defines terms;
15          ▸     requires health plans offered by a governmental entity that opts out of the federal
16     Mental Health Parity and Addiction Equity Act (the act) to substantially comply
17     with the act, including the act's financial requirements and treatment limitations;
18     and
19          ▸     provides limitations that a governmental entity may place on residential treatment
20     coverage.
21     Money Appropriated in this Bill:
22          None
23     Other Special Clauses:
24          None
25     Utah Code Sections Affected:
26     AMENDS:
27          31A-22-605.5, as last amended by Laws of Utah 2012, Chapter 127
28     

29     Be it enacted by the Legislature of the state of Utah:
30          Section 1. Section 31A-22-605.5 is amended to read:
31          31A-22-605.5. Application -- State mental health parity and addiction equity
32     requirement for exempt governmental entities.
33          (1) For purposes of this section ["insurance]:
34          (a) "Exempt governmental entity" means a governmental entity whose
35     employer-sponsored health plan opts out of the Mental Health Parity and Addiction Equity Act
36     in accordance with 42 U.S.C. Sec. 300gg-21(a)(2).
37          (b) "Governmental entity" means:
38          (i) the state;
39          (ii) a political subdivision of the state, as defined in Section 63G-7-102;
40          (iii) a law enforcement agency, as defined in Section 53-1-102, that employs one or
41     more law enforcement officers, as defined in Section 53-13-103; or
42          (iv) an institution of higher education.
43          (c) "Insurance mandate":
44          [(a)] (i) means a mandatory obligation with respect to coverage, benefits, or the number
45     or types of providers imposed on policies of accident and health insurance; and
46          [(b)] (ii) does not mean:
47          [(i)] (A) an administrative rule imposing a mandatory obligation with respect to
48     coverage, benefits, or providers unless that mandatory obligation was specifically imposed on
49     policies of accident and health insurance by statute; or
50          [(ii)] (B) an insurance mandate in an essential health benefits package imposed
51     pursuant to the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and the
52     Health Care Education Reconciliation Act of 2010, Pub. L. No. 111-152, and federal rules
53     related to their implementation.
54          (d) "Mental Health Parity and Addiction Equity Act" means 42 U.S.C. Sec. 300gg-26.
55          (e) "Residential treatment" means the same as that term is defined in Section
56     62A-2-101.
57          (f) "Substance use disorder benefit" means the same as that term is defined in 26
58     C.F.R. Sec. 54.9812-1(a).
59          (2) (a) Notwithstanding the provisions of Subsection 31A-1-103(3)(f), the following
60     shall apply to health coverage offered to the state employees' risk pool under Subsection
61     49-20-202(1)(a):
62          (i) any law enacted under this title that becomes effective after January 1, 2002, which
63     provides for an insurance mandate for policies of accident and health insurance; and
64          (ii) in accordance with Section 31A-22-613.5, disclosure requirements for coverage
65     limitations.
66          (b) Notwithstanding the provisions of Subsection 31A-1-103(3)(f), a health insurance
67     mandate enacted under this title after January 1, 2012, shall apply to:
68          (i) health coverage offered to the state employees' risk pool under Subsection
69     49-20-202(1)(a); and
70          (ii) health coverage offered to public school districts, charter schools, and institutions
71     of higher education under Subsection 49-20-201(1)(b).
72          (c) If health coverage offered to the state employees' risk pool under Subsections
73     49-20-201(1)(b) and 49-20-202(1)(a) offers coverage in the same manner and to the same
74     extent as the coverage required by an insurance mandate enacted under this title or coverage
75     that is greater than the insurance mandate enacted under this title, the coverage offered to state
76     employees under Subsections 49-20-201(1)(b) and 49-20-202(1)(a) will be considered in
77     compliance with the insurance mandate.
78          (d) (i) The programs regulated under Subsections 49-20-201(1)(b) and 49-20-202(1)(a)
79     shall report to the Retirement and Independent Entities Committee created under Section
80     63E-1-201 by November 30 of each year in which a mandate is enacted under the provisions of
81     this section.
82          (ii) The report shall include the costs and benefits of the particular mandatory
83     obligation.
84          (3) (a) An insurance mandate for policies of accident and health insurance enacted
85     under this title after January 1, 2012, shall apply to a health plan offered by a public school
86     district, a charter school, or a state funded institution of higher education that is not insured
87     through the Public Employees' Benefit and Insurance Program.
88          (b) If an insurance mandate for policies of accident and health insurance is enacted
89     under this title after January 1, 2012, the state shall determine whether each entity described in
90     Subsections (2) and (3)(a) offers coverage in the same manner and to the same extent, or
91     greater than the insurance coverage required in the mandate enacted after January 1, 2012.
92          (c) Before enacting an insurance mandate, the state shall, for each entity that does not
93     offer coverage in accordance with Subsection (3)(b):
94          (i) determine the cost to the entity of implementing the insurance mandate; and
95          (ii) appropriate money necessary to fund the full cost to the entity of implementing the
96     insurance mandate.
97          (4) (a) Notwithstanding the provisions of Subsection 31A-1-103(3)(f), a health plan
98     offered by an exempt governmental entity shall substantially comply in good faith with the
99     Mental Health Parity and Addiction Equity Act, including:
100          (i) using the same Ĥ→ or less restrictive ←Ĥ financial requirements for mental health and
100a     substance use disorder
101     benefits as for medical and surgical benefits; and
102          (ii) using quantitative treatment limitation requirements and non-quantitative treatment
103     limitation requirements, except as permitted by Subsection (4)(b).
104          (b) In covering mental health and substance use residential treatment, a health plan
105     offered by an exempt governmental entity may Ĥ→ [:
106          (i) develop preauthorization and participating provider standards at parity with benefits
107     provided for treatment at skilled nursing facilities;
108          (ii) limit participating provider status for reasons other than to reduce access to covered
109     services at parity with benefits provided for treatment at skilled nursing facilities; and
110          (iii)] ←Ĥ refer to the health plan's coverage of skilled nursing facilities for purposes of
111     quantitative Ĥ→ and non-quantitative ←Ĥ treatment limitation requirements.
112          (c) Nothing in this Subsection (4) may be construed as altering an exempt
113     governmental entity's exempt status under 42 U.S.C. Sec. 300gg-21(a)(2).
113a          Ĥ→ (d) The provisions of this Subsection (4) apply to a health plan that is entered into
113b     or renewed on or after July 1, 2022. ←Ĥ