TITLE XXXVII
INSURANCE

Chapter 417-E
COVERAGE FOR CERTAIN BIOLOGICALLY-BASED MENTAL ILLNESSES

Section 417-E:1

    417-E:1 Coverage for Certain Biologically-Based Mental Illnesses. –
I. For the purposes of this chapter "mental illness" means a clinically significant or psychological syndrome or pattern that occurs in a person and that is associated with present distress, a painful symptom or disability, impairment in one or more important areas of functioning, or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.
II. Notwithstanding any other provision of law, each insurer that issues or renews any policy of accident or health insurance and each nonprofit health service corporation under RSA 420-A and health maintenance organization under RSA 420-B providing benefits for disease or sickness in the state of New Hampshire shall provide benefits for treatment and diagnosis of certain biologically-based mental illnesses under the same terms and conditions and which are no less extensive than coverage provided for any other type of health care for physical illness.
III. The following mental illnesses, as defined in the most current edition of the Diagnostic and Statistical Manual (DSM) of Mental Disorders published by the American Psychiatric Association, shall be covered under this section:
(a) Schizophrenia and other psychotic disorders.
(b) Schizoaffective disorder.
(c) Major depressive disorder.
(d) Bipolar disorder.
(e) Anorexia nervosa and bulimia nervosa.

[Paragraph III(f) effective until July 1, 2024; see also paragraph III(f) set out below.]


(f) Obsessive-compulsive disorder, including pediatric autoimmune neuropsychiatric disorders, when treatment, including the use of intravenous immunoglobulin therapy, is ordered by a physician.

[Paragraph III(f) effective July 1, 2024; see also paragraph III(f) set out above.]


(f) Obsessive-compulsive disorder, including pediatric autoimmune neuropsychiatric disorders.
(g) Panic disorder.
(h) Pervasive developmental disorder or autism.
(i) Chronic post-traumatic stress disorder.
IV. The benefits required under this section shall begin when benefits provided under RSA 415:18-a and RSA 420-B:8-b, as applicable are exhausted.
V. The commissioner shall have the authority to enforce the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (the Act), including any amendments thereto and any federal rules adopted thereunder, and may adopt rules, under RSA 541-A, as may be necessary to effectuate any provisions of the Act that relate to the business of insurance.
V-a. Under examination authority in RSA 400-A:37, the commissioner shall periodically examine and evaluate health insurers, health service corporations, and health maintenance organizations for compliance with this chapter and with the Act. Such examination and evaluation shall include provider reimbursement practices. The result of such examinations and evaluations shall be made public to the fullest extent allowed under RSA 400-A:37.
V-b. (a) Health insurers, health service corporations, and health maintenance organizations shall include in their contracts with participating providers as defined under 420-J:3, reimbursement terms for mental health and substance use disorder treatment services that are on average, at least as favorable as those in their contracts for professional services provided by non-hospital affiliated primary care providers.
(1) Reimbursements for services paid to mental health and substance use disorder treatment providers shall meet the required standard if the reimbursement are, on average, equal to or greater than the relative Medicare reimbursements for the same service.
(2) Services considered in the comparison shall be those provided on an in-network basis in New Hampshire, and shall only consider comparisons for those services commonly provided by both non-hospital affiliated physicians and mental health and substance use disorder providers.
(3) Consistent with Medicare standards, professional licensure, certification, and telemedicine policies shall be recognized as factors warranting adjustment to reimbursement
(b) Compliance with subparagraph (a) shall not constitute compliance with the Mental Health Parity and Addiction Equity Act in 42 U.S.C. 300gg-26 and its implementing and related regulations in 45 C.F.R. 146.136, 45 C.F.R. 147.160, and 45 C.F.R. 156.115(a)(3). Health insurers, health service corporations, and health maintenance organizations shall, pursuant to 45 C.F.R. 146.136(c)(4)(i) and 45 C.F.R. 146.136(c)(4)(ii), ensure that when setting reimbursement rates for mental health and substance use disorder treatment providers, as written and in effect, any processes, strategies, evidentiary standards, or other factors used in establishing such reimbursement rates are comparable to, and are applied no more stringently than, any processes, strategies, evidentiary standards, or other factors used in establishing reimbursement rates for medical/surgical providers in the classification of benefits.
VI. Nothing in this section shall be construed to affect any obligation to provide services to an individual under an individualized family service plan or an individualized education program, as required under the federal Individuals With Disabilities Education Act, the state children's health insurance program authorized by 42 U.S.C. section 1397aa et seq., or the provision of services to an individual under any other federal or state law.

Source. 1994, 298:1. 1997, 190:13, 14. 2002, 204:3. 2009, 235:8. 2010, 188:13; 363:1. 2011, 224:282, eff. July 1, 2011. 2019, 277:1, 2, eff. Sept. 17, 2019; 277:3, eff. July 1, 2024; 283:1, 2, eff. Jan. 1, 2020. 2020, 39:51, eff. Sept. 27, 2020.

Section 417-E:2

    417-E:2 Coverage for Treatment of Pervasive Developmental Disorder or Autism. –
I. For the purposes of this chapter, treatment of pervasive developmental disorder or autism as required under RSA 417-E:1, III(h) shall include the following:
(a) Professional services and treatment programs, including applied behavioral analysis, necessary to produce socially significant improvements in human behavior or to prevent loss of attained skill or function. To be eligible for coverage, applied behavior analysis must be provided by a person professionally certified by the national Behavior Analyst Certification Board or performed under the supervision of a person professionally certified by the national Behavior Analyst Certification Board.
(b) Prescribed pharmaceuticals subject to the same terms and conditions of the policy as other prescribed pharmaceuticals.
(c) Direct or consultative services provided by a licensed professional including a licensed psychiatrist, licensed advanced practice registered nurse, licensed psychologist, or licensed clinical social worker; and
(d) Services provided by a licensed speech therapist, licensed occupational therapist, or licensed physical therapist.
II. An insurer may require submission of a treatment plan, including the frequency and duration of treatment, signed by the primary care provider, an appropriately credentialed treating specialist, a child psychiatrist, a pediatrician with a specialty in behavioral-developmental pediatrics, a neurologist with a specialty in child neurology, or a licensed psychologist with training in child psychology, that the treatment is medically necessary for the patient and is consistent with nationally recognized treatment standards for the condition such as those set forth by the American Academy of Pediatrics. An insurer may require an updated treatment plan no more frequently than on a semi-annual basis. Coverage shall not be denied on the basis that services are habilitative in nature.
III. The policy, contract, or certificate may limit coverage for applied behavior analysis to $36,000 per year for children 0 to 12 years of age, and $27,000 from ages 13 to 21. An insurer may not apply payments for coverage unrelated to autism spectrum disorders to any maximum benefit established under this paragraph.
IV. Nothing in this section shall be construed to affect any obligation by a school district or the state of New Hampshire to provide services to an individual under an individualized family service plan or an individualized education program, as required under the federal Individuals With Disabilities Education Act, the state children's health insurance program authorized by 42 U.S.C. section 1397aa et seq., or the provision of services to an individual under any other federal or state law.
V. The commissioner shall adopt rules, pursuant to RSA 541-A, relative to the insurance coverage requirements established under this section.

Source. 2010, 363:2. 2011, 224:283, eff. July 1, 2011.