Mandatory Coverage of Annual Behavioral Health Well Check

TRINIDAD NAVARRO COMMISSIONER STATE OF DELAWARE DEPARTMENT OF INSURANCE # DOMESTIC AND FOREIGN INSURERS BULLETIN NO. 134 TO: INSURANCE CARRIERS IN DELAWARE RE: MANDATORY COVERAGE OF ANNUAL BEHAVIORAL HEALTH WELL CHECK DATED: November 17, 2022 The purpose of this Bulletin is to notify all insurance carriers in Delaware that, beginning on January 1, 2024, carriers will be required to cover annual behavioral health well checks. Accordingly, the Department expects all filings for Plan Year 2024 to include annual behavioral health well check coverage as described more fully below. # Background House Bill No. 303, as amended by House Amendment No. 2, of the 151st General Assembly (“HB 303”), signed by the Governor on August 3, 2022, added new sections 3370E and 3571Z to the Delaware Insurance Code (18 Del.C. §§ 101, et seq.). Both new sections are identical, and they both require carriers to provide coverage for an annual behavioral health well check. HB 303 also creates an advisory committee tasked with creating recommendations for implementation of the Act. # Specifics of Annual behavioral health well check coverage HB 303 lists the common procedural terminology (CPT) codes under which providers must be reimbursed. Additionally, carriers are required to reimburse providers at the same rate that such CPT codes are reimbursed for the provision of other medical care, provided that reimbursement may be adjusted for payment of claims that are billed by a nonphysician clinician so long as the methodology to determine such adjustments is comparable to and applied no more stringently than the methodology for adjustments made for reimbursement of claims billed by nonphysician clinicians for other medical care, in accordance with 45 CFR 146.136(c)(4). The specific CPT Codes listed in the statute, which are to be updated by the Department through regulations if the CPT codes are altered, amended, changed, deleted, or supplemented, are as follows: NOTE: This Bulletin is intended solely for informational purposes. It is not intended to set forth legal rights, duties, or privileges, nor is it intended to provide legal advice. Readers should consult applicable statutes and rules and contact the Delaware Department of Insurance if additional information is needed. ♦INSURANCE.DELAWARE.GOV♦ 1351 W. NORTH ST., SUITE 101, DOVER, DELAWARE 19904 (302) 674-7300 DOVER♦ (302) 259-7554 GEORGETOWN♦ (302) 577-5280 WILMINGTON Page | 1 (1) 99381 (2) 99382 (3) 99383 (4) 99384 (5) 99385 (6) 99386 (7) 99387 (8) 99391 (9) 99392 (10) 99393 (11) 99394 (12) 99395 (13) 99396 (14) 99397. Questions about this Bulletin should be emailed to doi-legal@delaware.gov. This Bulletin shall be effective immediately and shall remain in effect unless withdrawn or superseded by subsequent law, regulation or bulletin. Trinidad Navarro Trinidad Navarro Delaware Insurance Commissioner NOTE: This Bulletin is intended solely for informational purposes. It is not intended to set forth legal rights, duties, or privileges, nor is it intended to provide legal advice. Readers should consult applicable statutes and rules and contact the Delaware Department of Insurance if additional information is needed. ♦INSURANCE.DELAWARE.GOV♦ 1351 W. NORTH ST., SUITE 101, DOVER, DELAWARE 19904 (302) 674-7300 DOVER♦ (302) 259-7554 GEORGETOWN♦ (302) 577-5280 WILMINGTON Page | 2