{"data":{"id":"us-de/18-del.-c.-3571u--2","jurisdiction":"us-de","citation":"18 Del. C. § 3571U","heading":"Mental Health Parity and Addiction Equity Act requirements [Effective Jan. 1, 2028].","body":"(a) Each health insurer offering group health insurance coverage that provides mental health disorder or substance use disorder benefits must submit a report to the Delaware Health Information Network and Commissioner on or before July 1 2019, and any year thereafter during which the insurer makes significant changes to how it designs and applies its medical management protocols; the report must contain the following information:\n(1) A description of the process used to develop or select the utilization review criteria for mental health disorder and substance use disorder benefits and the process used to develop or select the utilization review criteria for medical and surgical benefits.\n(2) Identification of all nonquantitative treatment limitations (NQTLs) that are applied to mental health disorder or substance use disorder benefits and medical and surgical benefits within each classification of benefits; there may be no separate NQTLs that apply to mental health disorder or substance use disorder benefits that do not also apply to medical and surgical benefits within any classification of benefits.\n(3) The results of an analysis that demonstrates that for the utilization review criteria described in paragraph (a)(1) of this section and for each NQTL identified in paragraph (a)(2) of this section, as written and in operation, the processes, strategies, evidentiary standards, or other factors used in applying the medical necessity criteria and each NQTL to mental health disorder or substance use disorder benefits within each classification of benefits are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the medical necessity criteria and each NQTL to medical and surgical benefits within the corresponding classification of benefits; at a minimum, the results of the analysis shall:\na. Identify the factors used to determine that an NQTL will apply to a benefit, including factors that were considered but rejected.\nb. Identify and define the specific evidentiary standards used to define the factors and any other evidence relied upon in designing each NQTL.\nc. Provide the comparative analyses, including the results of the analyses, performed to determine that the processes and strategies used to design each NQTL, as written, for mental health disorder or substance use disorder benefits are comparable to, and are applied no more stringently than, the processes and strategies used to design each NQTL, as written, for medical and surgical benefits.\nd. Provide the comparative analyses, including the results of the analyses, performed to determine that the processes and strategies used to apply each NQTL, in operation, for mental health disorder or substance use disorder benefits are comparable to, and applied no more stringently than, the processes or strategies used to apply each NQTL, in operation, for medical and surgical benefits.\ne. Disclose the specific findings and conclusions reached by the insurer that the results of the analyses above indicate that the carrier is in compliance with this section and the Mental Health Parity and Addiction Equity Act of 2008 [P.L. 104-204] and its implementing regulations, which includes 45 C.F.R. 146.136 and any other related federal regulations found in the Code of Federal Regulations.\n(4) Any information submitted to the Delaware Health Information Network and Commissioner by a carrier that is a trade secret or confidential or privileged commercial or financial information shall not be made public record.\n(5) The Insurance Commissioner shall retain the authority to enforce the provisions of this section. The provisions of this section shall not give rise to a private cause of action.\n(b) Disclosure of nonquantitative treatment limitation parity compliance analyses. —\n(1) A health-care provider, a current covered person, or a prospective covered person may request of a carrier any nonquantitative treatment limitation parity compliance analysis (NQTL parity compliance analysis) that a carrier is required to have completed by 29 U.S.C. § 1185a or 42 U.S.C. § 37 300gg-26.\n(2) Within 30 days of receiving a request pursuant to paragraph (b)(1) of this section, a carrier must provide a copy of the requested NQTL parity compliance analysis to the requesting person, free of charge.\n(3) Every health benefit plan policy and mental health disorder and substance use disorder provider contract must disclose the following information:\na. A notification of the right to request an NQTL parity compliance analysis.\nb. Instructions for how to request an NQTL parity compliance analysis.\n(c) The provisions published at 89 Federal Register 77586 et seq. on September 23, 2024, are incorporated into this section in their entirety and apply as state law. This incorporation remains in effect notwithstanding any subsequent amendment, repeal, or nonenforcement of the referenced federal provisions.\n(d) Under all health benefit plans delivered or issued for delivery in this State, if a carrier provides any benefits for a mental health disorder or substance use disorder in any classification of benefits, it must provide meaningful benefits for that mental health disorder or substance use disorder in every classification in which medical or surgical benefits are provided. For purposes of this subsection, “core treatments” means standard treatments or courses of treatment, therapy, service, or intervention indicated by generally accepted standards of mental health disorder or substance use disorder care. For purposes of this subsection, whether the benefits provided are considered “meaningful benefits” is determined in comparison to the benefits provided for medical conditions and surgical procedures in the classification and requires, at a minimum, coverage of benefits for that condition or disorder in each classification in which the carrier provides benefits for 1 or more medical conditions or surgical procedures. A carrier does not provide meaningful benefits under this subsection unless it provides benefits for core treatments for that condition or disorder in each classification in which the carrier provides benefits for core treatments for 1 or more medical conditions or surgical procedures. If there is no core treatment for a covered mental health disorder or substance use disorder with respect to a classification, the carrier is not required to provide benefits for core treatments for such condition or disorder in that classification, but must provide benefits for such condition or disorder in every classification in which medical or surgical benefits are provided.\n(e) For the purposes of determining comparability and stringency for nonquantitative treatment limitations, a carrier may not rely upon discriminatory factors or evidentiary standards to design a nonquantitative treatment limitation to be imposed on mental health disorder or substance use disorder benefits. A factor or evidentiary standard is discriminatory if the information, evidence, sources, or standards on which the factor or evidentiary standard are based are biased or not objective in a manner that discriminates against mental health disorder or substance use disorder benefits as compared to medical or surgical benefits.\n(f) A nonquantitative treatment limitation applicable to mental health disorder or substance use disorder benefits in a classification may not be more restrictive than the predominant nonquantitative treatment limitation applied to substantially all medical or surgical benefits in the classification. To test compliance with this subsection, a carrier shall collect and evaluate relevant data in a manner reasonably designed to assess the impact of the nonquantitative treatment limitation on relevant outcomes related to access to mental health disorder or substance use disorder benefits and medical or surgical benefits and carefully consider the impact as part of the plan’s evaluation. As part of its evaluation, the carrier may not disregard relevant outcomes data that it knows or reasonably should know suggest that a nonquantitative treatment limitation is associated with material differences in access to mental health disorder or substance use disorder benefits as compared to medical or surgical benefits. To the extent the relevant data evaluated suggest that the nonquantitative treatment limitation contributes to material differences in access to mental health disorder or substance use disorder benefits as compared to medical or surgical benefits in a classification, those differences will be considered a strong indicator of a noncompliant nonquantitative treatment limitation. Where the relevant data suggest that the nonquantitative treatment limitation contributes to material differences in access to mental health disorder or substance use disorder benefits as compared to medical or surgical benefits in a classification, the carrier must take reasonable action to address the material differences to ensure compliance and must document the actions that have been or are being taken by the carrier to address material differences in access to mental health disorder or substance use disorder benefits, as compared to medical or surgical benefits.","path":["Title 18. Insurance Code","Part I. Insurance","Chapter 35. Group and Blanket Health Insurance","Subchapter III. Provisions Applicable to Group and Blanket Health Insurance"],"source_url":"https://delcode.delaware.gov/title18/title18.pdf","current_through":"2026-10-01 (85 Del. Laws, c. 550)","vintage":"","retrieved_at":"2026-10-21T05:49:49Z","sha256":"4f3b6f63f0add17e5cdaa4558bdf8d417f313ccf70eeedfb28e8efdcb719cc80","source_id":"us-de","stale":false,"prev":"us-de/18-del.-c.-3571u","next":"us-de/18-del.-c.-3571v"},"notice":"GroundRules: Original legal text. Not legal advice."}