West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-64 - Mental Health Parity › Section 114-64-8 - Comparative Analysis Reporting for Non-Quantitative Treatment Limitations

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. An insurer or
				carrier shall provide annually to the Commissioner a comparative analysis
				demonstrating that, for any non-quantitative treatment limitation, including medical
				necessity criteria, as written and in operation, the processes, strategies,
				evidentiary standards, or other factors used in applying the medical necessity
				criteria and each non-quantitative treatment limitation to benefits for behavioral,
				mental health, and substance use disorders within each classification of benefits
				are comparable to, and are applied no more stringently than, the processes,
				strategies, evidentiary standards, or other factors used in applying the medical
				necessity criteria and each non-quantitative treatment limitation to medical and
				surgical benefits within the corresponding classification of benefits.
8.2. An insurer or carrier shall provide these
				comparative analyses results to the Commissioner, showing the following, at a
				minimum:
8.2.1. Identification of any factors used
				to determine whether a non-quantitative treatment limitation will apply to a
				benefit, including any factors considered but rejected;
8.2.2. Identify and define the specific
				evidentiary standards used to define the factors and any other evidence relied on in
				designing each non-quantitative treatment limitation;
8.2.3. Provide the comparative analyses, including
				any results of the analyses, performed to determine that the processes and
				strategies used to design each non-quantitative treatment limitation, as written,
				and the written processes and strategies used to apply to each nonquantitative
				treatment limitation for benefits for behavioral, mental health, and substance use
				disorders are comparable to, and are applied no more stringently than, the processes
				and strategies used to design and apply to each non-quantitative treatment
				limitation, as written, and the written processes and strategies used to apply to
				each non-quantitative treatment limitation for medical and surgical
				benefits;
8.2.4. Provide the comparative
				analyses, including the results of the analyses, performed to determine that the
				processes and strategies used to apply to each non-quantitative treatment
				limitation, in operation, for benefits for behavioral, mental health, and substance
				use disorders are comparable to, and are applied no more stringently than, the
				processes and strategies used to apply to each non-quantitative treatment
				limitation, in operation, for medical and surgical benefits; and
8.2.5. Disclose the specific findings and
				conclusions reached by the insurer or carrier that the results of the analyses
				indicate that each health benefit plan offered by the insurer or carrier complies
				with W.Va. Code §§
										33-15-4u,
				33-16-3f
				f,
				33-24-7u,
				33-25-8r
				or
				33-25A-8u,
				whichever is applicable, and this rule.