New Hampshire § 417-E-1 - Section 417-E:1 Coverage for Certain Biologically-Based Mental Illnesses.

§ 417-E-1. Section 417-E:1 Coverage for Certain Biologically-Based Mental Illnesses.

I. For the purposes of this chapter "mental illness" means a clinically significant or psychological syndrome or pattern that occurs in a person and that is associated with present distress, a painful symptom or disability, impairment in one or more important areas of functioning, or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. II. Notwithstanding any other provision of law, each insurer that issues or renews any policy of accident or health insurance and each nonprofit health service corporation under RSA 420-A and health maintenance organization under RSA 420-B providing benefits for disease or sickness in the state of New Hampshire shall provide benefits for treatment and diagnosis of certain biologically-based mental illnesses under access standards established in RSA 420-J:7, and under terms and conditions which are no less extensive than the coverage provided for any other type of health care for physical illness. III. The following mental illnesses, as defined in the most current edition of the Diagnostic and Statistical Manual (DSM) of Mental Disorders published by the American Psychiatric Association, shall be covered under this section: (a) Schizophrenia and other psychotic disorders. (b) Schizoaffective disorder. (c) Major depressive disorder. (d) Bipolar disorder. (e) Anorexia nervosa and bulimia nervosa. (f) Obsessive-compulsive disorder, including pediatric autoimmune neuropsychiatric disorders. (g) Panic disorder. (h) Pervasive developmental disorder or autism. (i) Chronic post-traumatic stress disorder. IV. The benefits required under this section shall begin when benefits provided under RSA 415:18-a and RSA 420-B:8-b, as applicable are exhausted. V. The commissioner shall have the authority to enforce the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (the Act), including any amendments thereto and any federal rules adopted thereunder, and may adopt rules, under RSA 541-A, as may be necessary to effectuate any provisions of the Act that relate to the business of insurance. V-a. The commissioner shall periodically require health insurers, health service corporations, and health maintenance organizations to submit the comparative analysis described in 42 U.S.C. section 300gg-26(a)(8)(A) for review to ensure compliance with this chapter and with the Act. To the extent allowable under state and federal law, such analysis shall be made public. V-b. (a) Health insurers, health service corporations, and health maintenance organizations shall include in their contracts with participating providers as defined under 420-J:3, reimbursement terms for mental health and substance use disorder treatment services that are on average, at least as favorable as those in their contracts for professional services provided by non-hospital affiliated primary care providers. (1) Reimbursements for services paid to mental health and substance use disorder treatment providers shall meet the required standard if the reimbursement are, on average, equal to or greater than the relative Medicare reimbursements for the same service. (2) Services considered in the comparison shall be those provided on an in-network basis in New Hampshire, and shall only consider comparisons for those services commonly provided by both non-hospital affiliated physicians and mental health and substance use disorder providers. (3) Consistent with Medicare standards, professional licensure, certification, and telemedicine policies shall be recognized as factors warranting adjustment to reimbursement (b) Compliance with subparagraph (a) shall not constitute compliance with the Mental Health Parity and Addiction Equity Act in 42 U.S.C. 300gg-26 and its implementing and related regulations in 45 C.F.R. 146.136, 45 C.F.R. 147.160, and 45 C.F.R. 156.115(a)(3). Health insurers, health service corporations, and health maintenance organizations shall, pursuant to 45 C.F.R. 146.136(c)(4)(i) and 45 C.F.R. 146.136(c)(4)(ii), ensure that when setting reimbursement rates for mental health and substance use disorder treatment providers, as written and in effect, any processes, strategies, evidentiary standards, or other factors used in establishing such reimbursement rates are comparable to, and are applied no more stringently than, any processes, strategies, evidentiary standards, or other factors used in establishing reimbursement rates for medical/surgical providers in the classification of benefits. VI. Nothing in this section shall be construed to affect any obligation to provide services to an individual under an individualized family service plan or an individualized education program, as required under the federal Individuals With Disabilities Education Act, the state children's health insurance program authorized by 42 U.S.C. section 1397aa et seq., or the provision of services to an individual under any other federal or state law.