PRIOR PRINTER'S NO. 2288
PRINTER'S NO. 3630
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1696
Session of
2019
INTRODUCED BY MURT, POLINCHOCK, SCHLOSSBERG, GABLER, MILLARD,
BOBACK, WHEELAND, CALTAGIRONE, GILLEN, McNEILL, SCHWEYER,
HOHENSTEIN, DAVIDSON, DeLUCA, BURGOS, SOLOMON, TOOHIL,
VITALI, OTTEN, ROZZI, KIRKLAND, HILL-EVANS, ISAACSON,
JOHNSON-HARRELL, DAY, MARKOSEK, STURLA, ROEBUCK, KAUFER,
FRANKEL AND READSHAW, JULY 8, 2019
AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF
REPRESENTATIVES, AS AMENDED, APRIL 27, 2020
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in health insurance coverage parity
and nondiscrimination, providing for annual reporting by
insurers. FURTHER PROVIDING FOR DEFINITIONS AND FOR ADOPTION
OF FEDERAL ACTS AND PROVIDING FOR ANNUAL ATTESTATION BY
INSURERS AND FOR INSURER ANALYSIS AND DISCLOSURE INFORMATION.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 604.1-B. Annual reporting by insurers.
An insurer shall annually file with the department such
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information as required by the department to determine the
insurer's compliance with the Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction Equity Act of 2008 (Public
Law 110-343, 122 Stat. 3881).
Section 2. This act shall take effect in 60 days.
SECTION 1. SECTION 603-B(A) OF THE ACT OF MAY 17, 1921
(P.L.682, NO.284), KNOWN AS THE INSURANCE COMPANY LAW OF 1921,
IS AMENDED BY ADDING DEFINITIONS TO READ:
SECTION 603-B. DEFINITIONS.
(A) GENERAL RULE.--THE FOLLOWING WORDS AND PHRASES WHEN USED
IN THIS ARTICLE SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS
SECTION UNLESS THE CONTEXT CLEARLY INDICATES OTHERWISE:
* * *
"HEALTH INSURANCE POLICY." A POLICY, SUBSCRIBER CONTRACT,
CERTIFICATE OR PLAN ISSUED BY AN INSURER THAT PROVIDES MEDICAL
OR HEALTH CARE COVERAGE. THE TERM DOES NOT INCLUDE ANY OF THE
FOLLOWING:
(1) AN ACCIDENT ONLY POLICY.
(2) A FIXED INDEMNITY POLICY.
(3) A LIMITED BENEFIT POLICY.
(4) A CREDIT ONLY POLICY.
(5) A DENTAL ONLY POLICY.
(6) A VISION ONLY POLICY.
(7) A SPECIFIED DISEASE POLICY.
(8) A MEDICARE SUPPLEMENT POLICY.
(9) A POLICY UNDER WHICH BENEFITS ARE PROVIDED BY THE
FEDERAL GOVERNMENT TO ACTIVE OR FORMER MILITARY PERSONNEL AND
THEIR DEPENDENTS.
(10) A LONG-TERM CARE OR DISABILITY INCOME POLICY.
(11) A WORKERS' COMPENSATION POLICY.
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(12) AN AUTOMOBILE MEDICAL PAYMENT POLICY.
* * *
"INSURED." A PERSON ON WHOSE BEHALF AN INSURER IS OBLIGATED
TO PAY COVERED HEALTH CARE EXPENSE BENEFITS OR PROVIDE HEALTH
CARE SERVICES UNDER AN HEALTH INSURANCE POLICY. THE TERM
INCLUDES A POLICYHOLDER, SUBSCRIBER, CERTIFICATE HOLDER, MEMBER,
DEPENDENT OR OTHER INDIVIDUAL WHO IS ELIGIBLE TO RECEIVE HEALTH
CARE SERVICES THROUGH A HEALTH INSURANCE POLICY.
* * *
"MH/SUD." MENTAL HEALTH AND SUBSTANCE USE DISORDER.
"MH/SUD PARITY FEDERAL GUIDANCE." FEDERAL GUIDANCE ISSUED
PURSUANT TO OR IN CONJUNCTION WITH MHPAEA AND THE MH/SUD PARITY
FEDERAL REGULATIONS.
"MH/SUD PARITY FEDERAL REGULATIONS." REGULATIONS PROMULGATED
BY THE FEDERAL GOVERNMENT TO IMPLEMENT MHPAEA, INCLUDING 45 CFR
146.136 (RELATING TO PARITY IN MENTAL HEALTH AND SUBSTANCE USE
DISORDER BENEFITS), 147.160 (RELATING TO PARITY IN MENTAL HEALTH
AND SUBSTANCE USE DISORDER BENEFITS) AND PT. 156 (RELATING TO
HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT,
INCLUDING STANDARDS RELATED TO EXCHANGES), AS AMENDED.
"MHPAEA." THE PAUL WELLSTONE AND PETE DOMENICI MENTAL HEALTH
PARITY AND ADDICTION EQUITY ACT OF 2008 (PUBLIC LAW 110-343, 122
STAT. 3881), ORIGINALLY ENACTED AS SECTION 2705 OF THE PUBLIC
HEALTH SERVICE ACT (58 STAT. 682, 42 U.S.C. § 300GG-5), AS
RENUMBERED AND AMENDED BY THE PATIENT PROTECTION AND AFFORDABLE
CARE ACT (PUBLIC LAW 111-148, 124 STAT. 119), TOGETHER WITH THE
HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010 (PUBLIC LAW
111-152, 124 STAT. 1029), AS SECTION 2726 OF THE PUBLIC HEALTH
SERVICE ACT (42 U.S.C. § 300GG-26), AS FURTHER AMENDED BY THE
ENHANCED COMPLIANCE WITH THE MH/SUD COVERAGE REQUIREMENTS UNDER
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§ 13001 OF THE 21ST CENTURY CURES ACT (PUBLIC LAW 114-255), AS
AMENDED.
* * *
"TREATMENT LIMITATION." A LIMIT ON THE SCOPE OF A BENEFIT OR
DURATION OF TREATMENT FOR A COVERED SERVICE.
* * *
SECTION 2. SECTION 604-B OF THE ACT IS AMENDED TO READ:
SECTION 604-B. ADOPTION OF FEDERAL ACTS.
INSURERS SHALL COMPLY WITH THE FEDERAL ACTS AS CONTAINED IN
SECTIONS [2701, 2702, 2705, 2707, 2721, 2753 AND 2754 OF THE
PUBLIC HEALTH SERVICE ACT (58 STAT. 682, 42 U.S.C. §§ 300GG,
300GG-1, 300GG-5, 300GG-7, 300GG-21, 300GG-53 AND 300GG-54).]
2704, 2705, 2722, 2726, 2728, 2753 AND 2754 OF THE PUBLIC HEALTH
SERVICE ACT (58 STAT. 682, 42 U.S.C. §§ 300GG-3, 300GG-4, 300GG-
21, 300GG-26, 300GG-28, 300GG-53 AND 300GG-54) AND THEIR
IMPLEMENTING AND RELATED FEDERAL REGULATIONS.
SECTION 3. THE ACT IS AMENDED BY ADDING SECTIONS TO READ:
SECTION 604.1-B. ANNUAL ATTESTATION BY INSURERS.
(A) STATEMENT REGARDING MHPAEA COMPLIANCE.--FOR THE FORM FOR
EACH HEALTH INSURANCE POLICY OFFERED, ISSUED OR RENEWED BY AN
INSURER IN THIS COMMONWEALTH TO WHICH MHPAEA APPLIES, THE
INSURER SHALL ANNUALLY FILE WITH THE DEPARTMENT A STATEMENT
ATTESTING TO THE INSURER'S DOCUMENTED ANALYSES OF ITS EFFORTS TO
COMPLY WITH MHPAEA AND THE MH/SUD PARITY FEDERAL REGULATIONS AS
OF THE DATE OF THE ATTESTATION.
(B) STATEMENT REGARDING MHPAEA NONAPPLICABILITY.--F OR THE
FORM FOR EACH HEALTH INSURANCE POLICY OFFERED, ISSUED OR RENEWED
BY AN INSURER IN THIS COMMONWEALTH THAT IS REQUIRED TO BE FILED
BUT TO WHICH MHPAEA DOES NOT APPLY, THE INSURER SHALL ANNUALLY
FILE WITH THE DEPARTMENT A STATEMENT ATTESTING TO THE
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NONAPPLICABILITY OF MHPAEA TO THE POLICY FORM.
(C) FILING.--EACH ATTESTATION REQUIRED UNDER THIS SECTION
MUST BE FILED BY APRIL 30 OF EACH YEAR OR WITH EACH FORM FILING,
WHICHEVER IS EARLIER.
SECTION 604.2-B. INSURER ANALYSIS AND DISCLOSURE DOCUMENTATION.
(A) I NFORMATION AVAILABLE FOR REVIEW.--FOR THE FORM FOR EACH
HEALTH INSURANCE POLICY OFFERED, ISSUED OR RENEWED BY AN INSURER
IN THIS COMMONWEALTH TO WHICH MHPAEA APPLIES, THE INSURER SHALL:
(1) PERFORM AND DOCUMENT A BASELINE PARITY ANALYSIS TO
DEMONSTRATE COMPLIANCE WITH MHPAEA AND THE MH/SUD PARITY
FEDERAL REGULATIONS FOR EACH QUANTITATIVE TREATMENT
LIMITATION AND EACH NONQUANTITATIVE TREATMENT LIMITATION
APPLICABLE TO AN MH/SUD BENEFIT.
(2) PERFORM AND DOCUMENT A PARITY ANALYSIS TO
DEMONSTRATE COMPLIANCE WITH MHPAEA AND THE MH/SUD PARITY
FEDERAL REGULATIONS FOR EACH CHANGE TO A QUANTITATIVE
TREATMENT LIMITATION OR NONQUANTITATIVE TREATMENT LIMITATION
APPLICABLE TO AN MH/SUD BENEFIT.
(3) PREPARE DISCLOSURE DOCUMENTATION REQUIRED BY SECTION
300GG-26(A)(4) OF MHPAEA (42 U.S.C. § 300GG-26(A)(4)), AS
AMENDED, CONSISTENT WITH THEN-CURRENT MH/SUD PARITY FEDERAL
GUIDANCE ISSUED UNDER SECTION 13001 OF THE 21ST CENTURY CURES
ACT (PUBLIC LAW 114-255, 42 U.S.C. § 300GG-26(6) AND (7)), AS
AMENDED.
(B) CONTENTS OF DOCUMENTED ANALYSIS.--EACH DOCUMENTED
ANALYSIS PERFORMED UNDER SUBSECTION (A)(1) AND (2) FOR A
NONQUANTITATIVE TREATMENT LIMITATION, INCLUDING MEDICAL
MANAGEMENT, MUST:
(1) I DENTIFY THE LIMITATION THAT IS APPLIED TO MH/SUD
BENEFITS AND THAT IS APPLIED TO MEDICAL AND SURGICAL
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BENEFITS.
(2) DESCRIBE THE PROCESS USED TO DEVELOP, SELECT OR
CONTINUE THE USE OF THE LIMITATION FOR MH/SUD BENEFITS AND
THE PROCESS USED TO DEVELOP, SELECT OR CONTINUE THE USE OF
THAT LIMITATION FOR MEDICAL AND SURGICAL BENEFITS.
(3) IDENTIFY AND DEFINE EACH FACTOR USED TO DETERMINE
THAT THE LIMITATION IS APPLICABLE TO THE MH/SUD BENEFIT,
INCLUDING PROCESSES, STRATEGIES AND EVIDENTIARY STANDARDS
USED TO DEVELOP, SELECT OR CONTINUE THE USE OF EACH FACTOR.
(4) CONTAIN A COMPARATIVE ANALYSIS, INCLUDING THE
RESULTS OF THE ANALYSIS, PERFORMED TO DETERMINE THAT, AS
DESIGNED AND WRITTEN, EACH FACTOR APPLICABLE TO THE
LIMITATION OF THE MH/SUD BENEFIT IS COMPARABLE TO THAT SAME
FACTOR AS APPLICABLE TO THE LIMITATION OF MEDICAL AND
SURGICAL BENEFITS.
(5) SPECIFY THE FINDINGS AND CONCLUSIONS IN THE ANALYSIS
THAT INDICATE THAT THE INSURER IS IN COMPLIANCE WITH THIS
ARTICLE, MHPAEA AND THE MH/SUD PARITY FEDERAL REGULATIONS.
(C) DOCUMENTATION.--FOR EACH NONQUANTITATIVE TREATMENT
LIMITATION, INCLUDING MEDICAL MANAGEMENT, THAT IS OR HAS BEEN IN
OPERATION AND APPLIED UNDER A HEALTH INSURANCE POLICY OFFERED,
ISSUED OR RENEWED BY AN INSURER IN THIS COMMONWEALTH, AN INSURER
SHALL MAINTAIN DOCUMENTATION TO DEMONSTRATE THAT EACH FACTOR
APPLICABLE TO THE LIMITATION FOR THE MH/SUD BENEFIT IS
COMPARABLE TO, AND IS APPLIED NO MORE STRINGENTLY THAN, THAT
SAME FACTOR AS APPLICABLE TO THE LIMITATION FOR MEDICAL AND
SURGICAL BENEFITS. THE DOCUMENTATION SHALL BE MAINTAINED IN
ACCORDANCE WITH ALL RECORD RETENTION REQUIREMENTS APPLICABLE TO
CONSUMER CLAIMS FILES.
( D) AVAILABILITY OF INFORMATION AND DOCUMENTATION.--AN
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INSURER SHALL MAKE THE INFORMATION AND DOCUMENTATION SPECIFIED
IN SUBSECTIONS (A), (B) AND (C) AVAILABLE AS FOLLOWS:
(1) THE INFORMATION AND DOCUMENTATION SPECIFIED IN
SUBSECTIONS (A), (B) AND (C) SHALL BE AVAILABLE TO THE
DEPARTMENT UPON REQUEST.
(2) THE INFORMATION AND DOCUMENTATION SPECIFIED IN
SUBSECTION (A)(3) SHALL BE AVAILABLE TO AN INSURED OR
PROVIDER AS REQUIRED BY SECTION 300GG-26(A)(4) OF MHPAEA (42
U.S.C. § 300GG-26(A)(4)) IN RESPONSE TO A GOOD FAITH REQUEST.
(3) IF APPLICABLE, AN INSURER MAY DESIGNATE THE
INFORMATION AND DOCUMENTATION PRODUCED IN ACCORDANCE WITH
THIS SUBSECTION AS A TRADE SECRET OR CONFIDENTIAL PROPRIETARY
INFORMATION.
SECTION 4. THIS ACT SHALL APPLY TO THE FORMS FOR EACH HEALTH
INSURANCE POLICY TO BE OFFERED, ISSUED OR RENEWED BY AN INSURER
IN THIS COMMONWEALTH AFTER DECEMBER 31, 2021.
SECTION 5. THIS ACT SHALL TAKE EFFECT IMMEDIATELY.
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