2
3
4
5
6
7 LONG TITLE
8 General Description:
9 This bill addresses mental health coverage requirements for health plans offered by
10 certain governmental entities.
11 Highlighted Provisions:
12 This bill:
13 ▸ defines terms;
14 ▸ requires health plans offered by a governmental entity that opts out of the federal
15 Mental Health Parity and Addiction Equity Act (the act) to substantially comply
16 with the act, including the act's financial requirements and treatment limitations;
17 ▸ provides limitations that a governmental entity may place on residential treatment
18 coverage; and
19 ▸ makes technical changes.
20 Money Appropriated in this Bill:
21 None
22 Other Special Clauses:
23 None
24 Utah Code Sections Affected:
25 AMENDS:
26 31A-22-605.5, as last amended by Laws of Utah 2012, Chapter 127
27
28 Be it enacted by the Legislature of the state of Utah:
29 Section 1. Section 31A-22-605.5 is amended to read:
30 31A-22-605.5. Application -- State mental health parity and addiction equity
31 requirement for exempt governmental entities.
32 (1) For purposes of this section [
33 (a) "Exempt governmental entity" means a governmental entity whose
34 employer-sponsored health plan opts out of the Mental Health Parity and Addiction Equity Act
35 in accordance with 42 U.S.C. Sec. 300gg-21(a)(2).
36 (b) "Governmental entity" means:
37 (i) the state;
38 (ii) a political subdivision of the state, as defined in Section 63G-7-102;
39 (iii) a law enforcement agency, as defined in Section 53-1-102, that employs one or
40 more law enforcement officers, as defined in Section 53-13-103; or
41 (iv) an institution of higher education.
42 (c) "Insurance mandate":
43 [
44 or types of providers imposed on policies of accident and health insurance; and
45 [
46 [
47 coverage, benefits, or providers unless that mandatory obligation was specifically imposed on
48 policies of accident and health insurance by statute; or
49 [
50 pursuant to the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and the
51 Health Care Education Reconciliation Act of 2010, Pub. L. No. 111-152, and federal rules
52 related to their implementation.
53 (d) "Mental Health Parity and Addiction Equity Act" means 42 U.S.C. Sec. 300gg-26.
54 (e) "Residential treatment" means the same as that term is defined in Section
55 62A-2-101.
56 (f) "Substance use disorder benefit" means the same as that term is defined in 26
57 C.F.R. Sec. 54.9812-1(a).
58 (2) (a) Notwithstanding the provisions of Subsection 31A-1-103(3)(f), the following
59 shall apply to health coverage offered to the state employees' risk pool under Subsection
60 49-20-202(1)(a):
61 (i) any law enacted under this title that becomes effective after January 1, 2002, which
62 provides for an insurance mandate for policies of accident and health insurance; and
63 (ii) in accordance with Section 31A-22-613.5, disclosure requirements for coverage
64 limitations.
65 (b) Notwithstanding the provisions of Subsection 31A-1-103(3)(f), a health insurance
66 mandate enacted under this title after January 1, 2012, shall apply to:
67 (i) health coverage offered to the state employees' risk pool under Subsection
68 49-20-202(1)(a); and
69 (ii) health coverage offered to public school districts, charter schools, and institutions
70 of higher education under Subsection 49-20-201(1)(b).
71 (c) If health coverage offered to the state employees' risk pool under Subsections
72 49-20-201(1)(b) and 49-20-202(1)(a) offers coverage in the same manner and to the same
73 extent as the coverage required by an insurance mandate enacted under this title or coverage
74 that is greater than the insurance mandate enacted under this title, the coverage offered to state
75 employees under Subsections 49-20-201(1)(b) and 49-20-202(1)(a) will be considered in
76 compliance with the insurance mandate.
77 (d) (i) The programs regulated under Subsections 49-20-201(1)(b) and 49-20-202(1)(a)
78 shall report to the Retirement and Independent Entities Committee created under Section
79 63E-1-201 by November 30 of each year in which a mandate is enacted under the provisions of
80 this section.
81 (ii) The report shall include the costs and benefits of the particular mandatory
82 obligation.
83 (3) (a) An insurance mandate for policies of accident and health insurance enacted
84 under this title after January 1, 2012, shall apply to a health plan offered by a public school
85 district, a charter school, or a state funded institution of higher education that is not insured
86 through the Public Employees' Benefit and Insurance Program.
87 (b) If an insurance mandate for policies of accident and health insurance is enacted
88 under this title after January 1, 2012, the state shall determine whether each entity described in
89 Subsections (2) and (3)(a) offers coverage in the same manner and to the same extent, or
90 greater than the insurance coverage required in the mandate enacted after January 1, 2012.
91 (c) Before enacting an insurance mandate, the state shall, for each entity that does not
92 offer coverage in accordance with Subsection (3)(b):
93 (i) determine the cost to the entity of implementing the insurance mandate; and
94 (ii) appropriate money necessary to fund the full cost to the entity of implementing the
95 insurance mandate.
96 (4) (a) Notwithstanding the provisions of Subsection 31A-1-103(3)(f), a health plan
97 offered by an exempt governmental entity shall substantially comply in good faith with the
98 Mental Health Parity and Addiction Equity Act, including:
99 (i) using the same or less restrictive financial requirements for mental health and
100 substance use disorder benefits as for medical and surgical benefits; and
101 (ii) except as provided in Subsection (4)(b), using quantitative treatment limitation
102 requirements and non-quantitative treatment limitation requirements.
103 (b) In covering mental health and substance use residential treatment, a health plan
104 offered by an exempt governmental entity may refer to the health plan's coverage of skilled
105 nursing facilities for purposes of quantitative and non-quantitative treatment limitation
106 requirements.
107 (c) This Subsection (4) does not alter an exempt governmental entity's exempt status
108 under 42 U.S.C. Sec. 300gg-21(a)(2).
109 (d) This Subsection (4) applies to a health plan that is entered into or renewed on or
110 after July 1, 2023.