Section 27-13-7-14.2 - "Treatment of a mental illness or substance abuse"; "act"; "nonqualitative treatment limitations"; reporting and analysis requirements for individual and group contracts(a) As used in this section, "treatment of a mental illness or substance abuse" means: (1) treatment for a mental illness, as defined in IC 12-7-2-130(1); and(2) treatment for drug abuse or alcohol abuse.(b) As used in this section, "act" refers to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Act of 2008 and any amendments thereto, plus any federal guidance or regulations relevant to that act, including 45 CFR 146.136, 45 CFR 147.136, 45 CFR 147.160, and 45 CFR 156.115(a)(3).(c) As used in this section, "nonquantitative treatment limitations" refers to those limitations described in 26 CFR 54.9812-1, 29 CFR 2590.712, and 45 CFR 146.136.(d) An individual contract or a group contract that provides coverage of services for treatment of a mental illness or substance abuse shall submit a report to the department not later than December 31 of each year that contains the following information: (1) A description of the processes: (A) used to develop or select the medical necessity criteria for coverage of services for treatment of a mental illness or substance abuse; and(B) used to develop or select the medical necessity criteria for coverage of services for treatment of other medical or surgical conditions.(2) Identification of all nonquantitative treatment limitations that are applied to:(A) coverage of services for treatment of a mental illness or substance abuse; and(B) coverage of services for treatment of other medical or surgical conditions; within each classification of benefits.
(e) There may be no separate nonquantitative treatment limitations that apply to coverage of services for treatment of a mental illness or substance abuse that do not apply to coverage of services for treatment of other medical or surgical conditions within any classification of benefits.(f) An individual contract or a group contract that provides coverage of services for treatment of a mental illness or substance abuse shall also submit an analysis showing the insurer's compliance with this section and the act to the department not later than December 31 of each year. The analysis must do the following: (1) Identify the factors used to determine that a nonquantitative treatment limitation will apply to a benefit, including factors that were considered but rejected.(2) Identify and define the specific evidentiary standards used to define the factors and any other evidence relied upon in designing each nonquantitative treatment limitation.(3) Provide the comparative analyses, including the results of the analyses, performed to determine the following: (A) That the processes and strategies used to design each nonquantitative treatment limitation for coverage of services for treatment of a mental illness or substance abuse are comparable to, and applied no more stringently than, the processes and strategies used to design each nonquantitative treatment limitation for coverage of services for treatment of other medical or surgical conditions.(B) That the processes and strategies used to apply each nonquantitative treatment limitation for treatment of a mental illness or substance abuse are comparable to, and applied no more stringently than, the processes and strategies used to apply each nonquantitative limitation for treatment of other medical or surgical conditions.(g) The department shall adopt rules to ensure compliance with this section and the applicable provisions of the act.Added by P.L. 103-2020,SEC. 5, eff. 7/1/2020.