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Deadline For Public Comment

Deadline: Jun 28, 2013

The deadline for public comment has expired. Contact the agency or primary contact person listed below for assistance.

Rule Details

Rule Number: 13P018
Title: Guidelines for Distinguishing Between Primary and Specialty Mental Health and Substance Abuse Services.
Type: Standard
Status: Adopted
Agency: Department of Financial Regulation
Legal Authority: Act 171 of 2012 § 11e; 8 V.S.A. § 4089b.
Summary: Vermont law requires a health insurance plan to provide coverage for treatment of a mental health condition and prohibits the plan from establishing a rate, term, or condition that places a greater burden on insured for access to treatment for a mental health condition than for access to treatment for other health conditions. A health insurance plan shall require no greater co-payment for primary mental health care or services than the co-payment applicable to care or services provided by a primary care provider under an insured's policy and not greater co-payment for specialty mental health care or services than the co-payment applicable to care or services provided by a specialist provider under an insured's policy. 8 V.S.A. Section 4089. This regulation prescribes guidelines for distinguishing between primary and specialty mental health services in order to implement this statutory requirement which takes effect on January 1, 2014.
Persons Affected: Health Insurers; insured individuals; the Department of Mental Health; the Department of Vermont Health Access; Vermont Division of Alcohol & Substance Abuse Programs; Vermont Council of Developmental & Mental Health Agencies; mental health care and substance abuse service providers.
Economic Impact: The Department engaged Oliver Wyman, an actuarial firm, to calculate the premium impact associated with implementing this rule. The estimated cost of requiring insurers to charge an insured an amount no greater than that applicable to primary care medical services for those services deems to be primary mental health and substance abuse services is minimal. The actuarial firm estimated the premium impact to be only 0.11 for ever 5.00 decrease in co-pay for 2013. For example, a $10 decrease in co-pay would result in an increase in premium of $1.14 per month for single person coverage, and $2.97 per month for family coverage in 2013. A separate analysis was done to look at induced utilization, meaning consumers may utilize more services when c
Posting date: May 22,2013

Hearing Information

Information for Hearing # 1
Hearing date:
06-21-2013 3:30 PM   
Location: Department of Financial Regulation, 3rd Floor Conference Room
Address: 89 Main Street
City: Montpelier
State: VT
Zip: 05620-3101
Hearing Notes:

Contact Information

Information for Contact # 1
Level: Primary    
Name: Karla Nuissl    
Agency: Department of Financial Regulation    
Address: 89 Main Street, City Center    
City: Montperlier    
State: VT    
Zip: 05620-3101    
Telephone: 802-828-2963    
Fax:    
Email: 
karla.nuissl@state.vt.us
     
 
   
Website Address:  http://www.dfr.vermont.gov/proposed-rules-and-regulations
     
 
   
Information for Contact # 2
Level: Secondary    
Name: Diane Lewis    
Agency: Department of Financial Regulation    
Address: 89 Main Street, City Center    
City: Montpelier    
State: VT    
Zip: 05620-3101    
Telephone: 802-828-2380    
Fax:    
Email: 
diane.lewis@state.vt.us
     
 
   
       

Keyword Information

Keywords:

mental health co-pays
mental health primary care services
mental health specialty care services
substance abuse primary care services
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