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Current as of January 01, 2022 | Updated by FindLaw Staff
(a) Information available for review.--For the form for each health insurance policy offered, issued or renewed by an insurer in this Commonwealth to which MHPAEA applies, the insurer shall:
(1) Perform and document a baseline parity analysis to demonstrate compliance with MHPAEA and the MH/SUD parity Federal regulations for each quantitative treatment limitation and each nonquantitative treatment limitation applicable to an MH/SUD benefit.
(2) Perform and document a parity analysis to demonstrate compliance with MHPAEA and the MH/SUD parity Federal regulations for each change to a quantitative treatment limitation or nonquantitative treatment limitation applicable to an MH/SUD benefit.
(3) Prepare disclosure documentation required by section 300gg-26(a)(4) of MHPAEA (42 U.S.C. § 300gg-26(a)(4)), as amended, consistent with then-current MH/SUD parity Federal guidance issued under section 13001 of the 21st Century Cures Act (Public Law 114-255, 42 U.S.C. § 300gg-26(a)(6) and (7)), as amended.
(b) Contents of documented analysis.--Each documented analysis performed under subsection (a)(1) and (2) for a nonquantitative treatment limitation, including medical management, must:
(1) Identify the limitation that is applied to MH/SUD benefits and that is applied to medical and surgical benefits.
(2) Describe the process used to develop, select or continue the use of the limitation for MH/SUD benefits and the process used to develop, select or continue the use of that limitation for medical and surgical benefits.
(3) Identify and define each factor used to determine that the limitation is applicable to the MH/SUD benefit, including processes, strategies and evidentiary standards used to develop, select or continue the use of each factor.
(4) Contain a comparative analysis, including the results of the analysis, performed to determine that, as designed and written, each factor applicable to the limitation of the MH/SUD benefit is comparable to that same factor as applicable to the limitation of medical and surgical benefits.
(5) Specify the findings and conclusions in the analysis that indicate that the insurer is in compliance with this article, MHPAEA and the MH/SUD parity Federal regulations.
(c) Documentation.--For each nonquantitative treatment limitation, including medical management, that is or has been in operation and applied under a health insurance policy offered, issued or renewed by an insurer in this Commonwealth, an insurer shall maintain documentation to demonstrate that each factor applicable to the limitation for the MH/SUD benefit is comparable to, and is applied no more stringently than, that same factor as applicable to the limitation for medical and surgical benefits. The documentation shall be maintained in accordance with all record retention requirements applicable to consumer claims files.
(d) Availability of information and documentation.--An insurer shall make the information and documentation specified in subsections (a), (b) and (c) available as follows:
(1) The information and documentation specified in subsections (a), (b) and (c) shall be available to the department upon request.
(2) The information and documentation specified in subsection (a)(3) shall be available to an insured or provider as required by section 300gg-26(a)(4) of MHPAEA (42 U.S.C. § 300gg-26(a)(4)) in response to a good faith request.
(3) If applicable, an insurer may designate the information and documentation produced in accordance with this subsection as a trade secret or confidential proprietary information.
Cite this article: FindLaw.com - Pennsylvania Statutes Title 40 P.S. Insurance § 908-14b. Insurer analysis and disclosure documentation - last updated January 01, 2022 | https://codes.findlaw.com/pa/title-40-ps-insurance/pa-st-sect-40-908-14b/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature or via Westlaw before relying on it for your legal needs.
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