HB 06612 Summary

• Expands the definition of "urgent care request" to include substance use disorder treatment, co-occurring mental disorders, and specific mental health services (inpatient, partial hospitalization, intensive outpatient), with expedited 24-hour determination timelines instead of 72 hours.

• Requires health carriers to provide more detailed adverse determination notices including clinical review criteria, scientific rationale for denials, and information about free assistance from the Office of the Healthcare Advocate, with emphasis on encouragement to appeal.

• Mandates use of specific clinical review criteria for substance use disorder and mental health treatment: American Society of Addiction Medicine's Patient Placement Criteria for substance use, and American Academy of Child and Adolescent Psychiatry guidelines for child/adolescent mental health services.

• Establishes that clinical peers conducting utilization reviews and grievance appeals must have appropriate credentials and training, including board certification in child and adolescent psychiatry or psychology for reviews involving minors.

• Requires the Insurance Commissioner to develop and implement a method to check mental health parity law compliance by health insurers by October 1, 2013, and to report annually on compliance check results and mental health parity issues.