PRINTER'S NO. 3821
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2323
Session of
2015
INTRODUCED BY KAUFER, DRISCOLL, HARHART, BOBACK, TOOHIL, TAYLOR,
RADER, COOK-ARTIS, RAPP, DAVIS, MURT, BAKER, GINGRICH AND
KAUFFMAN, SEPTEMBER 9, 2016
REFERRED TO COMMITTEE ON INSURANCE, SEPTEMBER 9, 2016
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, in regulation of insurers and related persons
generally, providing for mental health parity and addiction
treatment.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 40 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 37
MENTAL HEALTH PARITY
AND ADDICTION TREATMENT
Sec.
3701. Scope of chapter.
3702. Definitions.
3703. Reporting by insurer.
3704. Collection of information and report by department.
3705. Subsequent review and report.
3706. Identifying information.
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3707. Regulations.
3708. Expenses.
§ 3701. Scope of chapter.
This chapter relates to the collection and reporting of
statistics regarding addiction treatment services provided under
health plans and insurance policies, contracts and certificates.
§ 3702. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Adverse benefit determination." As defined under the
Patient Protection and Affordable Care Act (Public Law 111-148,
124 Stat. 119) and its implementing regulations.
"Department." The Insurance Department of the Commonwealth.
" Insurer. " An entity that issues or administers health
insurance policies or health plans and is subject to the
jurisdiction of the department. The term includes an entity
organized or existing under, or subject to, any of the
following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) The act of May 18, 1976 (P.L.123, No.54), known as
the Individual Accident and Sickness Insurance Minimum
Standards Act.
(4) Chapter 61 (relating to hospital plan corporations)
or 63 (relating to professional health services plan
corporations).
"MHPAEA." The Paul Wellstone and Pete Domenici Mental Health
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Parity and Addiction Equity Act of 2008 (Public Law 110-343, 122
Stat. 3881).
§ 3703. Reporting by insurer.
On or before January 1 of each year, an insurer shall provide
the following information to the department:
(1) The total number of the insurer's insureds and plan
members.
(2) The total number of the insurer's insureds and plan
members receiving covered addiction treatment.
(3) The addiction treatment covered by each plan or
policy, broken down by:
(i) Types of treatment.
(ii) Levels of care.
(iii) The average length of stay or units of service
within each level of care.
(iv) The number of adverse benefit determinations,
broken down by types of treatment and levels of care.
(v) For each type of treatment and level of care,
the percentage of claims and authorization or
preauthorization requests that are the subject of adverse
benefit determinations.
§ 3704. Collection of information and report by department.
(a) Information and report.--The department shall collect
the information gathered under section 3703 (relating to
reporting by insurer) and prepare a report containing the
information no later than July 1 of each year or as soon as
practicable.
(b) Dissemination of information.--The information and
report under subsection (a) shall be:
(1) Made available on the department's publicly
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accessible Internet website.
(2) Provided to the Department of Drug and Alcohol
Programs for the purposes under section 3705 (relating to
subsequent review and report).
§ 3705. Subsequent review and report.
(a) Review.--The Department of Drug and Alcohol Programs,
working in consultation with the department, shall review the
annual report under section 3704 (relating to collection of
information and report by department) to determine general
compliance by insurers regarding:
(1) MHPAEA and Federal guidelines or regulations issued
under MHPAEA, including the following, together with any
subsequent regulations and interim final rules implementing
MHPAEA:
(i) 26 CFR § 54.9812-1 (relating to parity in mental
health and substance use disorder benefits).
(ii) 29 CFR § 2590.712 (relating to parity in mental
health and substance use disorder benefits).
(iii) 42 CFR § 438.910 (relating to parity
requirements for financial requirements and treatment
limitations).
(iv) 42 CFR § 457.496 (relating to parity in mental
health and substance use disorder benefits).
(v) 45 CFR § 146.136 (relating to parity in mental
health and substance use disorder benefits).
(2) Section 604-B of the act of May 17, 1921 (P.L.682,
No.284), known as The Insurance Company Law of 1921.
(b) Report.--After its review under subsection (a), the
Department of Drug and Alcohol Programs shall submit a report of
findings to:
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(1) The chairperson and minority chairperson of the
Public Health and Welfare Committee of the Senate.
(2) The chairperson and minority chairperson of the
Human Services Committee of the House of Representatives.
(c) Dissemination of report.--The Department of Drug and
Alcohol Programs shall make the report under subsection (b)
available on its publicly accessible Internet website.
§ 3706. Identifying information.
(a) Duty of insurer.--An insurer shall take all necessary
steps to ensure that no identifying information regarding a
specific insured or plan member is made available to the
department, the Department of Drug and Alcohol Programs or the
public when carrying out the reporting obligations of this
chapter.
(b) Duty of departments.--The department and the Department
of Drug and Alcohol Programs shall take all necessary steps to
ensure that no identifying information regarding a specific
insured or plan member is made available to the other department
or the public when carrying out the requirements of this
chapter.
§ 3707. Regulations.
The department shall promulgate regulations necessary to
implement this chapter.
§ 3708. Expenses.
All expenses incurred in carrying out the collection, review
and reporting activities under this chapter, including the
expenses of the department and the Department of Drug and
Alcohol Programs regarding employees and any other professionals
or specialists retained in connection with these activities,
shall be charged to and paid by the insurer that is the subject
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of the collection, review or reporting.
Section 2. All acts or parts of acts are repealed insofar as
they are inconsistent with 40 Pa.C.S. Ch. 37.
Section 3. This act shall take effect immediately.
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