HF3904

Purpose

The bill aims to ensure health plans cover and pay for alcoholism, mental health, and chemical dependency services in a way that’s as accessible and fair as medical and surgical care. It strengthens parity rules, adds oversight, and requires reimbursement parity for services provided by clinical trainees through a specific care model.

What the bill would change

• Parity and cost-sharing
  • Outpatient and inpatient mental health, alcoholism, and chemical dependency services must not cost more or be more restricted than comparable outpatient or inpatient medical services.
  • Non-quantitative treatment limitations (NQTLs) used for mental health and substance use must be as comparable and no more stringent than those used for medical/surgical benefits.
• Legal compliance with federal parity laws
  • Health plans must meet parity requirements under federal laws (Mental Health Parity Act, Addiction Equity Act, and the Affordable Care Act) and any updates or guidance.
  • The state agency can request information from plans to verify parity and compare MH/SUD treatment with other medical conditions (e.g., prior authorizations, formulary design, claim denials, rehabilitation services).
• Primary care integration
  • Mental health therapy visits and medication maintenance visits, when within the provider’s scope of practice and plan credentialing, count as primary care visits for cost-sharing purposes.
• Psychiatric Collaborative Care Model (PCCM)
  • Plans covering alcoholism, mental health, or chemical dependency must reimburse PCCM services at 100% of the rate paid to an independently licensed mental health professional for the same services.
  • This parity doesn’t apply to certain managed care plans or county-based purchasing plans for specific public program enrollees (public programs under sections 256B or 256L).
  • The state commissioner can update the PCCM billing codes as codes change.
  • PCCM is defined as a team-based approach with a primary care provider, a care manager, and a psychiatric consultant, including structured care management and regular assessments.
• Billing codes and oversight
  • The required codes for PCCM services include 99492, 99493, 99494, G2214, and G0512.
  • Annual reporting and oversight: the commissioners (Commerce and Health) must publish a report by June 1 each year describing parity compliance, enforcement actions, and information provided to the public, while protecting privacy.
  • The report covers how compliance is reviewed and any actions taken, including details about the types of benefits examined and corrective actions.
• Public reporting and transparency
  • Information about protections for alcoholism, mental health, and chemical dependency parity must be made available to the public in clear language.
• Scope and exceptions
  • The PCCM reimbursement parity and related provisions have certain exclusions for specific public program enrollees in managed care or county-based purchasing arrangements.

Significant changes to existing law

• Establishes explicit cost-sharing and benefit parity requirements for alcoholism, mental health, and chemical dependency services.
• Adds strong protections against restrictive non-quantitative treatment limitations for MH/SUD benefits.
• Adds mandatory 100% reimbursement parity for PCCM services provided by clinical trainees (when within scope) and sets up a formal PCCM definition and requirements.
• Introduces annual compliance reporting and public reporting requirements to monitor and enforce parity.
• Integrates PCCM billing codes and updates into state law, with some exemptions for certain public programs.

Who is affected

• Health plan companies offering coverage for alcoholism, mental health, or chemical dependency services.
• Providers delivering mental health, chemical dependency, or alcoholism services, including clinical trainees under supervision.
• Consumers enrolled in plans offering MH/SUD benefits, who may see changes in cost-sharing and access to care.
• State agencies (Commerce and Health) responsible for oversight, reporting, and enforcement.

Practical implications

• Consumers may experience more consistent cost-sharing and access to mental health and addiction services.
• Plans may need to adjust formularies, prior authorization practices, and benefit designs to meet parity standards.
• Increased use of PCCM with clear billing codes could impact how behavioral health care is coordinated in primary care settings.

Relevant Terms - Mental Health Parity Act (MHPA) - Addiction Equity Act (AEDA) - Affordable Care Act (ACA) - Non-quantitative treatment limitations (NQTL) - Parity/comparability of benefits - Outpatient vs. inpatient services - Alcoholism, mental health, chemical dependency - Psychiatric Collaborative Care Model (PCCM) - Primary care provider, care manager, psychiatric consultant - Billing codes: 99492, 99493, 99494, G2214, G0512 - Prior authorization, drug formulary, claim denials, rehabilitation services - Section 256B, Section 256L (public program enrollees) - 245G.05 (chemical dependency), 245I.04 (clinical trainees) - 42 U.S.C. 18031j (federal parity provisions) - Compliance reporting and enforcement actions - Public reporting / transparency - Cost-sharing (outpatient and inpatient)