AN ACT to require insurers offering a health benefit plan in this state to submit an annual mental health and substance use disorder parity report to the commissioner of the department of insurance and the joint legislative oversight committee on health and human services beginning march 1, 2022.

The General Assembly of North Carolina enacts:

SECTION 1.  Article 3 of Chapter 58 of the General Statutes is amended by adding a new section to read:

§ 58‑3‑220.1.  Mental health and substance use disorder parity report.

(a)        No later than March 1 of each year, each insurer offering a health benefit plan in this State shall submit to the Commissioner and to the Joint Legislative Oversight Committee on Health and Human Services a report detailing the insurer's compliance with federal and State mental health and substance use disorder parity laws using data from the two calendar years preceding the date of submission of the report and accounting for each health benefit plan offered by that insurer.

(b)        Reports required under this section shall contain all of the following information:

(1)        Rates of utilization review for mental health and substance use disorder claims compared to medical and surgical claims, including rates of approval and denial, categorized by benefits provided under the following classifications:

a.         Inpatient in‑network.

b.         Inpatient out‑of‑network.

c.         Outpatient in‑network.

d.         Outpatient out‑of‑network.

e.         Emergency care.

f.          Prescription drugs.

(2)        The number of prior or concurrent authorization requests for mental health and substance use disorder services and the number of denials for those requests, compared with the number of prior or concurrent authorization requests for medical and surgical services and the number of denials for those requests, categorized by the same classifications identified in subdivision (1) of this subsection.

(3)        The rates of appeals of adverse determinations, including the rates of adverse determinations upheld and overturned, for mental health and substance use disorder claims compared with the rates of appeals of adverse determinations, including the rates of adverse determinations upheld and overturned, for medical and surgical claims.

(4)        The percentage of claims paid for in‑network mental health and substance use disorder services compared with the percentage of claims paid for in‑network medical and surgical services.

(5)        The percentage of claims paid for out‑of‑network mental health and substance use disorder services compared with the percentage of claims paid for out‑of‑network medical and surgical services.

(6)        A comparison of the cost‑sharing requirements, including copayments and coinsurance, and the benefit limitations, including limitations on the scope and duration of coverage, for mental health and substance use disorder services with the same cost‑sharing requirements and benefit limitations for medical and surgical services.

(7)        The number, by type, of in‑network providers that provide services for the treatment and diagnosis of substance use disorder and the number, by type, of in‑network providers that provide services for the diagnosis and treatment of mental health disorders, however defined by the health benefit plan. Additionally, of the number of in‑network providers, the percentage who are licensed to practice in this State and who are licensed to practice in contiguous states.

(8)        Any other data, information, or metric the Commissioner determines is necessary to measure compliance with mental health and substance use disorder parity laws. The Commissioner may not require the disclosure of any privileged or confidential information, trade secret, or protected health information.

(c)        No later than July 1 of each year, the Commissioner shall publish on the Department's website all reports submitted under this section for that calendar year.

(d)       No information submitted by an insurer shall disclose any protected health information of an insured.

SECTION 2.  This act becomes effective January 1, 2022.