November 4, 2014
The hearing is scheduled for 9:30 a.m. in the Insurance 5000 Building in Tumwater.
The purpose of the proposed rule is to align state and federal mental health parity laws and to create clear standards or formulas for health insurers to show how they are delivering mental health services and substance-use disorder treatments compared to medical and surgical benefits.
It also gives the insurance commissioner’s office better tools to measure if health insurers are delivering these services fairly and correctly.
Under the proposed rule, insurers must demonstrate the parity of their coverage between mental health services and substance-use disorders and medical and surgical benefits for each of six categories of services:
- Inpatient, in-network
- Inpatient, out-of-network
- Outpatient, in-network
- Outpatient, out-of-network
- Emergency care
- Prescription drugs
For example, if a health plan classifies a residential skilled nursing facility as inpatient medical care, it also must classify a mental health residential treatment facility as inpatient care.
The proposal also addresses how insurers must evaluate differences in copays/deductibles and treatment limitations between mental health services and medical and surgical benefits. It also requires insurers to give consumers the actual reason for denying a benefit, as well as access to documents and records to their claim upon request and free of charge.
The OIC plans to adopt the rule by Nov. 14. Once adopted, it takes effect in 31 days.