Sec. 14.2. (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.
As added by P.L.103-2020, SEC.5.
Structure Indiana Code
Article 13. Health Maintenance Organizations
Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage
27-13-7-0.1. Application of Certain Amendments to Chapter
27-13-7-1. Persons Entitled to Copies of Contracts
27-13-7-2. Deceptive Contract Provisions Prohibited
27-13-7-3. Contract Provisions
27-13-7-4. Compliance With Requirements; Ten Day Grace Period
27-13-7-5. Evidence of Coverage
27-13-7-6. Evidence of Coverage; Prohibited Provisions
27-13-7-7. Evidence of Coverage; Required Statement
27-13-7-7.5. Prohibition on Coverage of Abortion; Exceptions; Coverage Through Rider or Endorsement
27-13-7-8. Readability Standards
27-13-7-9. Approval of Forms by Commissioner
27-13-7-10. Coverage Outside Indiana; Commissioner's Approval Not Required
27-13-7-12. Additional Information Required by Commissioner
27-13-7-13. Continuation of Coverage Statement
27-13-7-14. Post-Mastectomy Coverage
27-13-7-14.5. Coverage for Nonexperimental, Surgical Treatment of Morbid Obesity
27-13-7-14.7. Coverage for Autism Spectrum Disorders
27-13-7-15. Dental Care Provisions Required
27-13-7-15.3. Breast Cancer Screening Mammography
27-13-7-16. Prostate Specific Antigen Test
27-13-7-17. Coverage for Colorectal Cancer Screening; Exception for Grandfathered Health Plans
27-13-7-18. Inherited Metabolic Disease Coverage
27-13-7-19. Coverage for Orthotic Devices and Prosthetic Devices
27-13-7-20. Prohibition on Chemotherapy Coverage Limitations
27-13-7-20.2. Coverage for Care Related to Cancer Clinical Trials
27-13-7-20.4. Applicability; Coverage for Methadone for Treatment of Pain
27-13-7-21. High Breast Density
27-13-7-23. Step Therapy Protocol
27-13-7-24. Coverage for Anatomical Gifts, Transplantation, or Related Health Care Services
27-13-7-24.5. Coverage for Chronic Pain Management
27-13-7-26. Coverage for Pediatric Neuropsychiatric Disorders