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H.411

Introduced by   Representatives Pugh of S. Burlington, Koch of Barre Town, Donahue of Northfield, Edwards of Brattleboro, Fisher of Lincoln, Grad of Moretown, Kiss of Burlington, McAllister of Highgate, McLaughlin of Royalton and Morrissey of Bennington

Referred to Committee on

Date:

Subject:  Health; mental health parity

Statement of purpose:  This bill proposes to enhance Vermont’s mental health parity laws.

AN ACT RELATING TO MENTAL HEALTH PARITY

It is hereby enacted by the General Assembly of the State of Vermont:

Sec. 1.  8 V.S.A. § 4089b is amended to read:

§ 4089b.  HEALTH INSURANCE COVERAGE,; MENTAL HEALTH AND

                SUBSTANCE ABUSE

(a)  As used in this section,:

(1)  “Health insurance plan” means any health insurance policy or health benefit plan offered by a health insurer, as defined in 18 V.S.A. § 9402(7) subdivision 9402(9) of Title 18.  Health insurance plan includes any health benefit plan offered or administered by the state, or any subdivision or instrumentality of the state.

(2)  “Mental health condition” means any condition or disorder involving mental illness or alcohol or substance abuse that falls under any of the diagnostic categories listed in the mental disorders section of the international classification of disease, as periodically revised.

(3)  “Rate, term, or condition” means any lifetime or annual payment limits, deductibles, copayments, coinsurance, and any other cost-sharing requirements, out-of-pocket limits, visit limits, and any other financial component of health insurance coverage that affects the insured.

(b)  A health insurance plan shall provide coverage for treatment of a mental health condition and shall not establish any rate, term, or condition that places a greater financial burden, financial or otherwise, on an insured for access to treatment for a mental health condition than for access to treatment for a physical any other health condition or for primary care, provided the treatment for the mental health condition is primary care for that condition.  Any deductible or out-of-pocket limits required under a health insurance plan shall be comprehensive for coverage of both mental health and physical all health conditions.

(c)  A health insurance plan that does not otherwise provide for management of care under the plan, or that does not provide for the same degree of management of care for all health conditions, may not provide coverage for treatment of mental health conditions through a managed care organization provided that the managed care organization is in compliance with the rules adopted by the commissioner that assure that the system for delivery of treatment for mental health conditions does not diminish or negate the purpose of this section.  The rules adopted by the commissioner shall assure that timely and appropriate access to care is available; that the quantity, location and specialty distribution of health care providers is adequate and that administrative or clinical protocols do not serve to reduce access to medically necessary treatment for any insured.

(d)  A health insurance plan shall be construed to be in compliance with this section if at least one choice for treatment of mental health conditions provided to the insured within the plan has rates, terms, and conditions that place no greater financial burden, financial or otherwise, on the insured than for access to treatment of physical conditions.  The commissioner may disapprove any plan that the commissioner determines to be inconsistent with the purposes of this section.

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Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us