1.1 	A bill for an act
1.2 	relating to health coverage; limiting cost-sharing requirements for the first four 
1.3 	outpatient mental health service visits;amending Minnesota Statutes 2020, sections 
1.4 	62A.149, subdivision 1; 62A.152, subdivision 2; 62Q.47.
1.5 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.6 	Section 1. Minnesota Statutes 2020, section 62A.149, subdivision 1, is amended to read:
1.7 		Subdivision 1.Application. The provisions of this section apply to all group policies 
1.8 	of accident and health insurance and group subscriber contracts offered by nonprofit health 
1.9 	service plan corporations regulated under chapter 62C, and to a plan or policy that is 
1.10 	individually underwritten or provided for a specific individual and family members as a 
1.11 	nongroup policy, when the policies or subscriber contracts are issued or delivered in 
1.12 	Minnesota or provide benefits to Minnesota residents enrolled thereunder.
1.13 	This section does not apply to policies designed primarily to provide coverage payable 
1.14 	on a per diem, fixed indemnity or nonexpense incurred basis or policies that provide accident 
1.15 	only coverage.
1.16 	Every insurance policy or subscriber contract included within the provisions of this 
1.17 	subdivision, upon issuance or renewal, shall provide coverage that complies with the 
1.18 	requirements of section 62Q.47, paragraphs (b) and (c) (d), for the treatment of alcoholism, 
1.19 	chemical dependency or drug addiction to any Minnesota resident entitled to coverage.

2.1 	Sec. 2. Minnesota Statutes 2020, section 62A.152, subdivision 2, is amended to read:
2.2 		Subd. 2.Minimum benefits.  All group policies and all group subscriber contracts 
2.3 	providing benefits for mental or nervous disorder treatments in a hospital shall also provide 
2.4 	coverage that complies with the requirements of section 62Q.47, paragraphs (b) and (c) (d).

2.5 	Sec. 3. Minnesota Statutes 2020, section 62Q.47, is amended to read:
2.6 	62Q.47 ALCOHOLISM, MENTAL HEALTH, AND CHEMICAL DEPENDENCY 
2.7 	SERVICES.
2.8 	(a) All health plans, as defined in section 62Q.01, that provide coverage for alcoholism, 
2.9 	mental health, or chemical dependency services, must comply with the requirements of this 
2.10 	section.
2.11 	(b) Cost-sharing requirements and benefit or service limitations for outpatient mental 
2.12 	health and outpatient chemical dependency and alcoholism services, except for persons 
2.13 	placed in chemical dependency services under Minnesota Rules, parts 9530.6600 to 
2.14 	9530.6655, must not place a greater financial burden on the insured or enrollee, or be more 
2.15 	restrictive than those requirements and limitations for outpatient medical services.
2.16 	(c) Notwithstanding paragraph (b), a health plan shall not impose a cost-sharing 
2.17 	requirement greater than $25 per visit for the first four outpatient mental health service 
2.18 	visits that occur within a contract year. Any cost-sharing imposed for the first four visits 
2.19 	shall be applied toward the enrollee's annual deductible, if applicable, and to the out-of-pocket 
2.20 	maximum amount. For purposes of this paragraph, "cost-sharing" includes deductibles, 
2.21 	coinsurance, or co-payments, but does not include premiums, balance billing amounts for 
2.22 	non-network providers, or the cost of noncovered services.
2.23 	(c) (d) Cost-sharing requirements and benefit or service limitations for inpatient hospital 
2.24 	mental health and inpatient hospital and residential chemical dependency and alcoholism 
2.25 	services, except for persons placed in chemical dependency services under Minnesota Rules, 
2.26 	parts 9530.6600 to 9530.6655, must not place a greater financial burden on the insured or 
2.27 	enrollee, or be more restrictive than those requirements and limitations for inpatient hospital 
2.28 	medical services.
2.29 	(d) (e) A health plan company must not impose an NQTL with respect to mental health 
2.30 	and substance use disorders in any classification of benefits unless, under the terms of the 
2.31 	health plan as written and in operation, any processes, strategies, evidentiary standards, or 
2.32 	other factors used in applying the NQTL to mental health and substance use disorders in 
2.33 	the classification are comparable to, and are applied no more stringently than, the processes, 
3.1 	strategies, evidentiary standards, or other factors used in applying the NQTL with respect 
3.2 	to medical and surgical benefits in the same classification.
3.3 	(e) (f) All health plans must meet the requirements of the federal Mental Health Parity 
3.4 	Act of 1996, Public Law 104-204; Paul Wellstone and Pete Domenici Mental Health Parity 
3.5 	and Addiction Equity Act of 2008; the Affordable Care Act; and any amendments to, and 
3.6 	federal guidance or regulations issued under, those acts.
3.7 	(f) (g) The commissioner may require information from health plan companies to confirm 
3.8 	that mental health parity is being implemented by the health plan company. Information 
3.9 	required may include comparisons between mental health and substance use disorder 
3.10 	treatment and other medical conditions, including a comparison of prior authorization 
3.11 	requirements, drug formulary design, claim denials, rehabilitation services, and other 
3.12 	information the commissioner deems appropriate.
3.13 	(g) (h) Regardless of the health care provider's professional license, if the service provided 
3.14 	is consistent with the provider's scope of practice and the health plan company's credentialing 
3.15 	and contracting provisions, mental health therapy visits and medication maintenance visits 
3.16 	shall be considered primary care visits for the purpose of applying any enrollee cost-sharing 
3.17 	requirements imposed under the enrollee's health plan.
3.18 	(h) (i) By June 1 of each year, beginning June 1, 2021, the commissioner of commerce, 
3.19 	in consultation with the commissioner of health, shall submit a report on compliance and 
3.20 	oversight to the chairs and ranking minority members of the legislative committees with 
3.21 	jurisdiction over health and commerce. The report must:
3.22 	(1) describe the commissioner's process for reviewing health plan company compliance 
3.23 	with United States Code, title 42, section 18031(j), any federal regulations or guidance 
3.24 	relating to compliance and oversight, and compliance with this section and section 62Q.53;
3.25 	(2) identify any enforcement actions taken by either commissioner during the preceding 
3.26 	12-month period regarding compliance with parity for mental health and substance use 
3.27 	disorders benefits under state and federal law, summarizing the results of any market conduct 
3.28 	examinations. The summary must include: (i) the number of formal enforcement actions 
3.29 	taken; (ii) the benefit classifications examined in each enforcement action; and (iii) the 
3.30 	subject matter of each enforcement action, including quantitative and nonquantitative 
3.31 	treatment limitations;
3.32 	(3) detail any corrective action taken by either commissioner to ensure health plan 
3.33 	company compliance with this section, section 62Q.53, and United States Code, title 42, 
3.34 	section 18031(j); and
4.1 	(4) describe the information provided by either commissioner to the public about 
4.2 	alcoholism, mental health, or chemical dependency parity protections under state and federal 
4.3 	law.
4.4 	The report must be written in nontechnical, readily understandable language and must be 
4.5 	made available to the public by, among other means as the commissioners find appropriate, 
4.6 	posting the report on department websites. Individually identifiable information must be 
4.7 	excluded from the report, consistent with state and federal privacy protections.