KRS 304.17A-661: Treatment of mental health conditions to be covered under terms or

conditions that are no more restrictive than terms or conditions for treatment

of physical health conditions -- Parity coverage for nonquantitative treatment

limitations and medical necessity criteria.

(1) Notwithstanding any other provision of law:

(a) 1. A health benefit plan issued or renewed on or after January 1, 2022, that

provides coverage for treatment of a mental health condition shall

provide coverage of any treat ment of a mental health condition under

terms or conditions that are no more restrictive than the terms or

conditions provided for treatment of a physical health condition.

2. Expenses for mental health and physical health conditions shall be

combined for purposes of meeting deductible and out -of-pocket limits

required under a health benefit plan.

3. A health benefit 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 or mental health conditions may

provide coverage for treatment of mental health conditions through a

managed care organization;

(b) With respect to mental health condition benefits in any classification of

benefits, a health benefit plan req uired to comply with paragraph (a) of this

subsection shall not impose:

1. A nonquantitative treatment limitation that does not apply to medical

and surgical benefits in the same classification; and

2. Medical necessity criteria or a nonquantitative treatm ent limitation

unless, under the terms of the plan, as written and in operation, any

processes, strategies, evidentiary standards, or other factors used in

applying the criteria or limitation to mental health condition benefits in

the classification are comparable to, and are applied no more stringently

than, the processes, strategies, evidentiary standards, or other factors

used in applying the criteria or limitation to medical and surgical

benefits in the same classification; and

(c) Paragraph (b) of this subsection shall be construed to require, at a minimum,

compliance with the requirements for nonquantitative treatment limitations set

forth in the Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C.

sec. 300gg-26, as amended, and any related federal regulations, as amended,

including but not limited to 45 C.F.R. secs. 146.136, 147.160, and

156.115(a)(3).

(2) (a) An insurer that issues or renews a health benefit plan that is subject to the

provisions of this section shall submit an annual repo rt to the commissioner

on or before April 1 of each year following January 1, 2022, that contains the

following:

1. A description of the process used to develop or select the medical

necessity criteria for both mental health condition benefits and medical

and surgical benefits;

2. Identification of all nonquantitative treatment limitations applicable to

benefits and services covered under the plan that are applied to both

mental health condition benefits and medical and surgical benefits

within each classification of benefits;

3. The results of an analysis that demonstrates compliance with subsection

(1)(b) and (c) of this section for the medical necessity criteria described

in subparagraph 1. of this paragraph and for each nonquantitative

treatment limitation identified in subparagraph 2. of this paragraph, as

written and in operation. At a minimum, the results of the analysis shall:

a. Identify the factors used to determine that a nonquantitative

treatment limitation will apply to a benefit, including factors that

were considered but rejected;

b. Identify and define the specific evidentiary standards used to

define the factors and any other evidence relied upon in designing

each nonquantitative treatment limitation;

c. Provide the comparative analyses, including the results of the

analyses, performed to determine that the processes and strategies:

i. Used to design each nonquantitative treatment limitation, as

written, and the as -written processes and strategies used to

apply the nonquantitative treatment limitation to mental

health condition benefits are comparable to, and are applied

no more stringently than, the processes and strategies used to

design each nonquantitative treatment limitation, as written,

and the as -written processes and strategies used to apply the

nonquantitative treatment limitation to medical and surgical

benefits; and

ii. Used to apply each nonquantitative treatment limitation, in

operation, for mental health condition benefits are

comparable to, and are applied no more stringently than, the

processes and strategies used to apply each nonquantitative

treatment limitation, in operation, for medical and surgical

benefits; and

d. Disclose the specific findings and conclusions reached by the

insurer that the results of the analyses performed under this

subparagraph indicate t hat the insurer is in compliance with

subsection (1)(b) and (c) of this section; and

4. Any additional information that may be prescribed by the commissioner

for use in determining compliance with the requirements of this section.

(b) The annual report shall be submitted in a manner and format prescribed by the

commissioner through administrative regulation.

(3) A willful violation of this section shall constitute an act of discrimination and shall

be an unfair trade practice under this chapter. The remedie s provided under Subtitle

12 of this chapter shall apply to conduct in violation of this section.