PRINTER'S NO. 1040
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
878
Session of
2023
INTRODUCED BY TARTAGLIONE, DILLON, KANE, COLEMAN, FONTANA,
SCHWANK AND COSTA, AUGUST 16, 2023
REFERRED TO BANKING AND INSURANCE, AUGUST 16, 2023
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, in regulation of insurers and related persons
generally, providing for addiction treatment services
information collection and reporting.
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 42
ADDICTION TREATMENT SERVICES INFORMATION
COLLECTION AND REPORTING
Sec.
4201. Scope of chapter.
4202. Definitions.
4203. Reporting by insurer.
4204. Collection of information and report by department.
4205. Subsequent review and report.
4206. Identifying information.
4207. Regulations.
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4208. Expenses.
§ 4201. 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
and compliance with other laws.
§ 4202. 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:
"Addiction treatment." Treatment provided in or by a
facility licensed by the Department of Drug and Alcohol
Programs.
"Adverse benefit determination." As follows:
(1) A denial, reduction or termination of, or a failure
to provide or make payment in whole or in part for, a
benefit.
(2) The term includes any of the following:
(i) A denial, reduction, termination or failure to
provide or make payment that is based on a determination
of a participant's or beneficiary's eligibility to
participate in a plan.
(ii) With respect to group health plans, a denial,
reduction or termination of, or a failure to provide or
make payment in whole or in part for, a benefit resulting
from the application of any utilization review.
(iii) A failure to cover an item or service for
which benefits are otherwise provided because it is
determined to be experimental or investigational or not
medically necessary or appropriate.
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" Insurer. " As follows:
(1) An entity that issues or administers health
insurance policies or health plans and is subject to the
jurisdiction of the department.
(2) The term includes an entity organized or existing
under, or subject to, any of the following:
(i) The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921.
(ii) The act of December 29, 1972 (P.L.1701,
No.364), known as the Health Maintenance Organization
Act.
(iii) The act of May 18, 1976 (P.L.123, No.54),
known as the Individual Accident and Sickness Insurance
Minimum Standards Act.
(iv) 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
Parity and Addiction Equity Act of 2008 (Public Law 110-343, 122
Stat. 3765).
"Review." A utilization review, authorization,
preauthorization, concurrent review, retrospective review or
audit with respect to a benefit and any other process that
results or could result in an adverse benefit determination.
§ 4203. Reporting by insurer.
On or before April 30 of each year, an insurer shall provide
a report containing the following information to the department
for the preceding calendar year:
(1) The total number of the insurer's insureds and plan
members.
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(2) The total number of the insurer's insureds and plan
members who received addiction treatment covered or
authorized by the insurer and by any subcontractor acting on
behalf of the insurer.
(3) For each product line, the units of addiction
treatment authorized by the insurer and its subcontractors,
broken down by treatment setting, including inpatient
hospital detoxification, inpatient hospital rehabilitation,
inpatient nonhospital detoxification, inpatient nonhospital
residential, partial hospitalization and outpatient.
(4) For each product line, the units of addiction
treatment reimbursed or otherwise paid for by the insurer and
its subcontractors, broken down by treatment setting,
including inpatient hospital detoxification, inpatient
hospital rehabilitation, inpatient nonhospital
detoxification, inpatient nonhospital residential, partial
hospitalization and outpatient.
(5) For each product line, the average length of stay or
units of service for each treatment setting, including
inpatient hospital detoxification, inpatient hospital
rehabilitation, inpatient nonhospital detoxification,
inpatient nonhospital residential, partial hospitalization
and outpatient.
(6) For each product line, the number and percentage of
reviews conducted by the insurer and its subcontractors, the
number and percentage of reviews conducted by the insurer and
its subcontractors that resulted in denials and the number
and percentage of reviews conducted by the insurer and its
subcontractors that resulted in other adverse benefit
determinations, other than denials, for each of the
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following:
(i) Inpatient hospital detoxification for alcohol
and drug addiction.
(ii) Inpatient hospital rehabilitation for alcohol
and drug addiction.
(iii) Inpatient nonhospital detoxification for
alcohol and drug addiction.
(iv) Inpatient nonhospital residential for alcohol
and drug addiction.
(v) Partial hospitalization for alcohol and drug
addiction.
(vi) Outpatient services for alcohol and drug
addiction.
(vii) Medical or surgical services.
§ 4204. Collection of information and report by department.
The information and report under section 4203 (relating to
reporting by insurer) shall be:
(1) Made available on the department's publicly
accessible Internet website.
(2) Provided to the Department of Drug and Alcohol
Programs for the purposes under section 4205 (relating to
subsequent review and report).
§ 4205. 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 4203 (relating to reporting by
insurer) 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
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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 review under subsection (a), the
Department of Drug and Alcohol Programs shall submit a report of
findings to:
(1) The chairperson and minority chairperson of the
Health and Human Services 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.
§ 4206. 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
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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.
§ 4207. Regulations.
The department shall promulgate regulations necessary to
implement this chapter.
§ 4208. 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
of the collection, review or reporting.
Section 2. All acts or parts of acts are repealed insofar as
they are inconsistent with the addition of 40 Pa.C.S. Ch. 42.
Section 3. This act shall take effect immediately.
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