Amendments for HB25-1002
House Journal, January 29
36 HB25-1002 be amended as follows, and as so amended, be referred to
37 the Committee of the Whole with favorable
38 recommendation:
39
40 Amend printed bill, page 2, line 3, strike "(5.5)(b),".
41
42 Page 6, strike lines 4 and 5 and substitute "PROVIDE SERVICES TO MAKE
43 AVAILABLE THE COVERED SERVICE".
44
45 Page 7, strike lines 19 through 27.
46
47 Page 8, strike lines 1 through 3.
48
49 Page 9, line 8, strike "SOCIOLOGY," and substitute "SOCIAL WORK,
50 PSYCHIATRIC NURSING,".
51
52 Page 10, strike lines 9 through 20 and substitute:
53
54 "(VI) "UTILIZATION REVIEW CRITERIA" MEANS AN EVALUATION OF
55 THE NECESSITY, APPROPRIATENESS, AND EFFICIENCY OF THE USE OF
56 HEALTH-CARE SERVICES, PROCEDURES, AND FACILITIES, INCLUDING
1 OUT-OF-NETWORK SERVICES REQUIRED PURSUANT TO SUBSECTION
2 (5.5)(a)(V)(D) OF THIS SECTION. "UTILIZATION REVIEW CRITERIA" DOES
3 NOT INCLUDE AN INDEPENDENT MEDICAL EXAMINATION PROVIDED FOR IN
4 ANY POLICY.
5 SECTION 2. Act subject to petition - effective date. This act
6 takes effect January 1, 2026; except that, if a referendum petition is filed
7 pursuant to section 1 (3) of article V of the state constitution against this
8 act or an item, section, or part of this act within the ninety-day period
9 after final adjournment of the general assembly, then the act, item,
10 section, or part will not take effect unless approved by the people at the
11 general election to be held in November 2026 and, in such case, will take
12 effect on the date of the official declaration of the vote thereon by the
13 governor.".
14
15
House Journal, February 7
30 Amendment No. 1, Health & Human Services Report, dated January 29,
31 2025, and placed in member’s bill file; Report also printed in House
32 Journal, January 29, 2025.
33
34 Amendment No. 2, by Representative Brown:
35
36 Amend the Health and Human Services Committee Report, dated January
37 29, 2025, page 1, after line 1 insert:
38
39 "Page 2 of the printed bill, line 4, strike the second "and".
40
41 Page 2 of the bill, line 5, strike "(5.5)(c.5)" and substitute "(5.5)(c.5), and
42 (5.5)(e)".".
43
44 Page 1 of the report, strike line 15 and substitute "ANY POLICY.
45 (e) (I) SUBSECTION (5.5)(d) OF THIS SECTION DOES NOT EXPAND
46 COVERAGE REQUIREMENTS BEYOND THE STATE ESSENTIAL HEALTH
47 BENEFITS BENCHMARK PLAN AS REQUIRED PURSUANT TO 45 CFR 156.111.
48 (II) IF AN EXCLUSION FOR BEHAVIORAL HEALTH, MENTAL HEALTH,
49 OR SUBSTANCE USE DISORDER SERVICES IS NOT PERMITTED UNDER THE
50 MHPAEA, COVERAGE FOR THESE SERVICES MUST MEET THE
51 REQUIREMENTS OF SUBSECTION (5.5)(d) of THIS SECTION.".
52
53 Amendment No. 3, by Representative Brown:
54
55 Amend the Health and Human Services Committee Report, dated January
56 29, 2025, page 1, strike line 1.
1 Page 1 of the report, line 2, strike "Page" and substitute "Amend printed
2 bill, page".
3
4 Page 1 of the report, line 4, strike "19" and substitute "21".
5
6 Page 1 of the report, line 5, strike "3." and substitute "3 and substitute
7 "(5.5) is implemented and COMPLIANTLY administered; in compliance
8 with federal law and shall adopt rules to establish reasonable time periods
9 for visits with a provider for treatment of a behavioral, mental health, or
10 substance use disorder after an initial visit with a provider.
11 (II) MAY ADOPT RULES TO ESTABLISH CARRIER UTILIZATION
12 REVIEW COMPLIANCE IN ACCORDANCE WITH SUBSECTIONS (5.5)(a)(I.5)(B)
13 AND (5.5)(a)(I.5)(C) OF THIS SECTION;
14 (III) MAY ADOPT RULES AS NECESSARY TO SPECIFY DATA TESTING
15 REQUIREMENTS TO DETERMINE PLAN DESIGN AND APPLICATION OF PARITY
16 COMPLIANCE FOR NONQUANTITATIVE TREATMENT LIMITATIONS USING
17 OUTCOMES DATA;
18 (IV) MAY ADOPT RULES TO SET STANDARD DEFINITIONS FOR
19 COVERAGE REQUIREMENTS, INCLUDING PROCESSES, STRATEGIES,
20 EVIDENTIARY STANDARDS, AND OTHER FACTORS;
21 (V) MAY ADOPT RULES TO ESTABLISH SPECIFIC TIMELINES FOR
22 CARRIER COMPLIANCE TO PROVIDE COMPARATIVE ANALYSIS INFORMATION
23 TO THE DIVISION FOR REVIEW, INCLUDING THE EFFECT OF A CARRIER’S
24 LACK OF SUFFICIENT COMPARATIVE ANALYSES TO DEMONSTRATE
25 COMPLIANCE; AND
26 (V) MAY ADOPT RULES TO ESTABLISH REASONABLE TIME PERIODS
27 AND DOCUMENTATION OF SUCH TIME PERIODS FOR VISITS WITH A
28 PROVIDER FOR TREATMENT OF A BEHAVIORAL, MENTAL HEALTH, OR
29 SUBSTANCE USE DISORDER AFTER AN INITIAL VISIT WITH A PROVIDER.".".
30
31 Amendment No. 4, by Representative Brown:
32
33 Amend printed bill, page 3, strike lines 2 and 3 and substitute "placement,
34 medical necessity, and utilization".
35
36 Page 3, line 15, after the semicolon add "AND".
37
38 Page 3, strike lines 16 through 27.
39
40 Page 4, strike lines 1 through 10.
41
42 Reletter succeeding sub-subparagraph accordingly.
43
44 Amendment No. 5, by Representative Brown:
45
46 Amend printed bill, page 4, strike lines 21 through 27.
47
48 Page 5, strike lines 1 through 7 and substitute:
49 "(B) IN CONDUCTING UTILIZATION REVIEW OF COVERED SERVICES
50 FOR THE DIAGNOSIS, PREVENTION, AND TREATMENT OF BEHAVIORAL OR
51 MENTAL HEALTH DISORDERS, A HEALTH BENEFIT PLAN SHALL APPLY THE
52 CRITERIA AND GUIDELINES SET FORTH IN THE MOST RECENT VERSION OF
53 THE TREATMENT CRITERIA DEVELOPED BY UNAFFILIATED NATIONALLY
54 RECOGNIZED NOT-FOR-PROFIT CLINICAL SPECIALTY ASSOCIATIONS OF THE
55 RELEVANT BEHAVIORAL OR MENTAL HEALTH DISORDERS. IN CONDUCTING
56 UTILIZATION REVIEW OF COVERED SERVICES FOR THE DIAGNOSIS,
1 PREVENTION, AND TREATMENT OF SUBSTANCE USE DISORDERS, A HEALTH
2 BENEFIT PLAN SHALL APPLY THE CRITERIA SPECIFIED IN SUBSECTION
3 (5.5)(a)(I)(B) OF THIS SECTION.
4 (C) IN CONDUCTING UTILIZATION REVIEW RELATING TO SERVICE
5 INTENSITY, LEVEL OF CARE PLACEMENT, OR ANY OTHER PATIENT CARE
6 DECISIONS THAT ARE WITHIN THE SCOPE OF THE SOURCES SPECIFIED IN
7 SUBSECTIONS (5.5)(a)(I)(B) AND (5.5)(a)(I.5)(B) OF THIS SECTION, A
8 HEALTH BENEFIT PLAN SHALL NOT APPLY DIFFERENT, ADDITIONAL,
9 CONFLICTING, OR MORE RESTRICTIVE UTILIZATION REVIEW CRITERIA THAN
10 THE CRITERIA SET FORTH IN THOSE SOURCES. FOR ALL SERVICE INTENSITY
11 AND LEVEL OF CARE PLACEMENT DECISIONS, THE HEALTH BENEFIT PLAN
12 MUST AUTHORIZE PLACEMENT AT THE SERVICE INTENSITY AND LEVEL OF
13 CARE CONSISTENT WITH THE ASSESSMENT OF THE COVERED PERSON USING
14 THE RELEVANT PATIENT PLACEMENT CRITERIA SPECIFIED IN SUBSECTIONS
15 (5.5)(a)(I)(B) AND (5.5)(a)(I.5)(B) OF THIS SECTION. IF THERE IS A
16 DISAGREEMENT, AS PART OF THE ADVERSE BENEFIT DETERMINATION, THE
17 HEALTH BENEFIT PLAN MUST PROVIDE FULL DETAIL OF ITS ASSESSMENT
18 AND THE RELEVANT CRITERIA USED IN THE ASSESSMENT TO THE PROVIDER
19 AND THE COVERED PERSON.
20 (D) IN CONDUCTING UTILIZATION REVIEW THAT IS OUTSIDE THE
21 SCOPE OF THE CRITERIA SPECIFIED IN SUBSECTIONS (5.5)(a)(I)(B) AND
22 (5.5)(a)(I.5)(B) OF THIS SECTION OR RELATED TO ADVANCEMENTS IN
23 TECHNOLOGY OR TYPES OF LEVELS OF CARE THAT ARE NOT ADDRESSED IN
24 THE MOST RECENT VERSIONS OF THE SOURCES SPECIFIED IN THOSE
25 SUBSECTIONS, A HEALTH BENEFIT PLAN SHALL CONDUCT UTILIZATION
26 REVIEW IN ACCORDANCE WITH SUBSECTION (5.5)(a)(I.5)(A) OF THIS
27 SECTION. IF A HEALTH BENEFIT PLAN PURCHASES OR LICENSES UTILIZATION
28 REVIEW CRITERIA PURSUANT TO THIS SUBSECTION (5.5)(a)(I.5)(D), THE
29 HEALTH BENEFIT PLAN SHALL VERIFY AND DOCUMENT BEFORE USE THAT
30 THE CRITERIA COMPLY WITH THE REQUIREMENTS OF SUBSECTION
31 (5.5)(a)(I.5)(A) OF THIS SECTION.".
32
33 Reletter succeeding sub-subparagraph accordingly.
34
35 As amended, ordered engrossed and placed on the Calendar for Third
36 Reading and Final Passage.
37
Senate Journal, February 21
After consideration on the merits, the Committee recommends that HB25-1002 be
amended as follows, and as so amended, be referred to the Committee of the Whole with
favorable recommendation and with a recommendation that it be placed on the Consent
Calendar.
Amend reengrossed bill, page 4, strike lines 17 through 26 and substitute "THE
CRITERIA SET FORTH IN THOSE SOURCES. IF THE REQUESTED SERVICE INTENSITY
OR LEVEL OF CARE PLACEMENT IS INCONSISTENT WITH THE HEALTH BENEFIT
PLAN'S ASSESSMENT USING THE RELEVANT CRITERIA, AS PART OF ANY ADVERSE
BENEFIT DETERMINATION, THE HEALTH BENEFIT PLAN SHALL PROVIDE FULL
DETAIL OF ITS ASSESSMENT AND THE RELEVANT CRITERIA USED IN THE
ASSESSMENT TO THE PROVIDER AND THE COVERED PERSON.".
Page 8, lines 2 and 3, strike "SUBSECTIONS (5.5)(a)(I.5)(B) AND (5.5)(a)(I.5)(C)"
and substitute "SUBSECTION (5.5)(a)(I.5)".
Page 11, line 6, strike "SUBSECTION (5.5)(d) OF THIS SECTION" and substitute
"THIS SUBSECTION (5.5)".
Page 11, line 12, strike "SUBSECTION (5.5)(d) of THIS SECTION." and substitute
"THIS SUBSECTION (5.5).".
Health &
Human
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