Healthcare (Insurance)

The act adds kidney function screening services as mandated preventive health-care services for which insurance policies or contracts in the state must provide total-cost coverage. Coverage for kidney function screening services will be implemented for all large employer health benefit policies or contracts issued or renewed in this state on or after January 1, 2027, and coverage will be implemented for all individual and small group health benefit plans issued or renewed in this state on or after January 1, 2028, as long as the state is not required to defray the cost of the coverage of the kidney function screening services.     The act permits the exclusion of the 'State Employees Group Benefits Act' from this mandate and exempts certain high deductible plans from having to provide total-cost coverage for such services.(Note: This summary applies to this bill as enacted.)

The act requires a health insurance carrier that provides prescription drug benefits to require that:The utilization review requirements, including prior authorization and step therapy, for a non-opioid drug prescribed and approved by the federal food and drug administration (FDA) for the treatment or management of chronic or acute pain (non-opioid pain management drug) are no more restrictive than the least restrictive utilization review requirements for opioid drugs prescribed for the treatment or management of chronic or acute pain; andThe cost-sharing, copayment, or deductible for a non-opioid pain management drug is not greater than the cost-sharing, copayment, or deductible for an opioid drug prescribed for the treatment or management of chronic or acute pain.     The act requires each individual and small group health benefit plan issued or renewed on or after January 1, 2027, and each large employer health benefit plan issued or renewed on and after January 1, 2028, to ensure there is at least one non-opioid pain management drug available as a clinically appropriate alternative for an opioid pain management drug. If the division of insurance determines that coverage for a non-opioid pain management drug offered by individual and small group health benefit plans requires state defrayal of the cost of coverage, the requirement to make a non-opioid pain management drug available is inoperative.     The state employee health benefit plan is excluded from the requirements of the act.     The act appropriates $15,415 to the department of regulatory agencies for use by the division of insurance to implement the act.(Note: This summary applies to this bill as enacted.)

If a mental health provider, substance use disorder provider, or psychiatric nurse (provider) has not submitted a claim for a period of at least 12 months, the act requires a commercial insurance carrier (carrier) to contact the provider to confirm the provider's participation in the carrier's provider network and to determine whether the provider is accepting new patients.     The act includes mental health providers, substance use disorder providers, and psychiatric nurses as providers who may participate in a carrier's provider network.     The act requires carriers to admit prelicensed providers into the carrier's network and to reimburse prelicensed providers for services rendered when provided under the supervision of a mental health provider, substance use disorder provider, or psychiatric nurse.     The act requires a clinical social worker to complete 3,000 hours of practice prior to licensure.(Note: This summary applies to this bill as enacted.)

The act makes changes to the dispute resolution process between health insurance carriers (carriers) and out-of-network health-care providers (providers) by requiring a carrier to provide, with each payment made to a provider, a remittance advice that: Identifies when the associated health benefit plan is regulated by the state and when the payment is made pursuant to services received from an out-of-network provider or at an out-of-network facility; andProvides the carrier's median in-network reimbursement rate for out-of-network claims.(Note: This summary applies to this bill as enacted.)