Okla. Stat. tit. 36, § 36-6060.11

A. Subject to the limitations set forth in this section and

Sections 6060.12 and 6060.13 of this title, any health benefit plan

that is offered, issued, or renewed in this state on or after

January 1, 2000, shall provide benefits for treatment of mental

health and substance use disorders.

B. 1. Benefits for mental health and substance use disorders

shall be equal to benefits for treatment of and shall be subject to

the same preauthorization and utilization review mechanisms and

other terms and conditions as all other physical diseases and

disorders including, but not limited to:

a. coverage of inpatient hospital services for either

twenty-six (26) days or the limit for other covered

illnesses, whichever is greater,

b. coverage of outpatient services,

c. coverage of medication,

d. maximum lifetime benefits,

e. copayments,

f. coverage of home health visits,

g. individual and family deductibles, and

h. coinsurance.

2. Treatment limitations applicable to mental health or

substance use disorder benefits shall be no more restrictive than

the predominant treatment limitations applied to substantially all

medical and surgical benefits covered by the plan. There shall be

no separate treatment limitations that are applicable only with

respect to mental health or substance abuse disorder benefits.

C. A health benefit plan shall not impose a nonquantitative

treatment limitation with respect to mental health and substance use

disorders in any classification of benefits unless, under the terms

of the health benefit plan as written and in operation, any

processes, strategies, evidentiary standards or other factors used

in applying the nonquantitative treatment limitation to mental

health disorders in the classification are comparable to and applied

Oklahoma Statutes - Title 36. Insurance Page 1105

no more stringently than to medical and surgical benefits in the

same classification.

D. All health benefit plans must meet the requirements of the

federal Paul Wellstone and Pete Domenici Mental Health Parity and

Addiction Equity Act of 2008, as amended, and federal guidance or

regulations issued under these acts including 45 CFR 146.136, 45 CFR

147.160, 45 CFR 156.115(a)(3), 42 U.S.C. 300gg-26(a), 29 U.S.C.

1185a(a), and 26 U.S.C. 9812.

E. Beginning on or after January 1, 2000, each insurer that

offers, issues or renews any individual or group health benefit plan

providing mental health or substance use disorder benefits shall

submit an annual report to the Insurance Commissioner on or before

April 1 of each year that contains the following:

1. A description of the process used to develop or select the

medical necessity criteria for mental health and substance use

disorder benefits and the process used to develop or select the

medical necessity criteria for medical and surgical benefits;

2. Identification of all nonquantitative treatment limitations

applied to both mental health and substance use disorder benefits

and medical and surgical benefits within each classification of

benefits; and

3. The results of an analysis that demonstrates that for the

medical necessity criteria described in paragraph 1 of this

subsection and for each nonquantitative treatment limitation

identified in paragraph 2 of this subsection, as written and in

operation, the processes, strategies, evidentiary standards or other

factors used in applying the medical necessity criteria and each

nonquantitative treatment limitation to mental health and substance

use disorder benefits within each classification of benefits are

comparable to and are applied no more stringently than to medical

and surgical benefits in the same classification of benefits. At a

minimum, the results of the analysis shall:

a. identify and clearly define the factors and terms used

to determine that a nonquantitative treatment

limitation will apply to a benefit,

b. identify and clearly define the specific evidentiary
tion of benefits are

comparable to and are applied no more stringently than to medical

and surgical benefits in the same classification of benefits. At a

minimum, the results of the analysis shall:

a. identify and clearly define the factors and terms used

to determine that a nonquantitative treatment

limitation will apply to a benefit,

b. identify and clearly define the specific evidentiary

standards used to define the factors and any other

evidence relied upon in designing each nonquantitative

treatment limitation,

c. provide the detailed, written, and reasoned

comparative analyses including the results of the

analyses performed to determine that the processes and

strategies used to design each nonquantitative

treatment limitation, as written, and the as written

processes and strategies used to apply the

nonquantitative treatment limitation to mental health

and substance use disorder benefits are comparable to

Oklahoma Statutes - Title 36. Insurance Page 1106

and applied no more stringently than the processes and

strategies used to design each nonquantitative

treatment limitation, as written, and the as written

processes and strategies used to apply the

nonquantitative treatment limitation to medical and

surgical benefits,

d. provide the detailed, written, and reasoned

comparative analyses including the results of the

analyses performed to determine that the processes and

strategies used to apply each nonquantitative

treatment limitation, in operation, for mental health

and substance use disorder benefits are comparable to

and applied no more stringently than the processes or

strategies used to apply each nonquantitative

treatment limitation for medical and surgical benefits

in the same classification of benefits, and

e. disclose the specific findings and conclusions reached

by the insurer that the results of the analyses

required by this subsection indicate whether the

insurer is in compliance with this section and the

Paul Wellstone and Pete Domenici Mental Health Parity

and Addiction Equity Act of 2008, as amended, and its

implementing and related regulations including 45 CFR

146.136, 45 CFR 147.160, 45 CFR 156.115(a)(3), 42

U.S.C. 300gg-26(a), 29 U.S.C. 1185a(a), and 26 U.S.C.

9812.

F. The findings and conclusions shall include sufficient detail

to fully explain such findings including methodologies for the

analyses, detailed descriptions of each treatment limitation for

mental health and substance use disorder benefits compared to each

treatment limitation for medical and surgical benefits, and detailed

descriptions of all criteria involved for approving mental health

and substance use disorder benefits as compared to the criteria

involved for approving medical and surgical benefits.

G. The Commissioner shall implement and enforce any applicable

provisions of the Paul Wellstone and Pete Domenici Mental Health

Parity and Addiction Equity Act of 2008, as amended, and federal

guidance or regulations issued under these acts including 45 CFR

146.136, 45 CFR 147.136, 45 CFR 147.160, 45 CFR 156.115(a)(3), 42

U.S.C. 300gg-26(a), 29 U.S.C. 1185a(a), and 26 U.S.C. 9812.

H. The Commissioner shall issue guidance and standardized

reporting templates to ensure compliance with the provisions of this

section. Guidance shall include examples of non-quantitative

treatment limitations as identified by the Centers for Medicare and

Medicaid Services, the Department of Labor, and the Employee

Benefits Security Administration.

Oklahoma Statutes - Title 36. Insurance Page 1107

I. No later than December 31, 2021, and by December 31 of each

year thereafter, the Commissioner shall make available to the public

the reports submitted by insurers, as required in subsection E of

this section, during the most recent annual cycle.

1. The Commissioner shall identify insurers that have failed in

whole or in part to comply with the full extent of reporting
Insurance Page 1107

I. No later than December 31, 2021, and by December 31 of each

year thereafter, the Commissioner shall make available to the public

the reports submitted by insurers, as required in subsection E of

this section, during the most recent annual cycle.

1. The Commissioner shall identify insurers that have failed in

whole or in part to comply with the full extent of reporting

required in this section and shall make a reasonable attempt to

obtain missing reports or information by June 1 of the following

year.

2. The reports submitted by insurers and the identification by

the Commissioner of noncompliant insurers shall be made available to

the public by posting on the Internet website of the Insurance

Department. Any information that is confidential or a trade secret

shall be redacted prior to the public posting.

J. The Commissioner may promulgate rules pursuant to the

provisions of this section and any provisions of the Paul Wellstone

and Pete Domenici Mental Health Parity and Addiction Equity Act of

2008, as amended, that relate to the business of insurance.