(1) For the purposes of this section, "mental
health services" means medically necessary outpatient and
inpatient services provided to treat mental disorders covered by
the diagnostic categories listed in the most current version of
the diagnostic and statistical manual of mental disorders,
published by the American psychiatric association, on July 24,
2005, or such subsequent date as may be provided by the
administrator by rule, consistent with the purposes of chapter 6,
Laws of 2005, with the exception of the following categories,
codes, and services: (a) Substance related disorders; (b) life
transition problems, currently referred to as "V" codes, and
diagnostic codes 302 through 302.9 as found in the diagnostic and
statistical manual of mental disorders, 4th edition, published by
the American psychiatric association; (c) skilled nursing
facility services, home health care, residential treatment, and
custodial care; and (d) court ordered treatment unless the
authority's or contracted insuring entity's medical director
determines the treatment to be medically necessary.
(2) All health benefit plans offered to public employees and
their covered dependents under this chapter that provide coverage
for medical and surgical services shall provide:
(a) For all health benefit plans established or renewed on
or after January 1, 2006, coverage for:
(i) Mental health services. The copayment or coinsurance
for mental health services may be no more than the copayment or
coinsurance for medical and surgical services otherwise provided
under the health benefit plan. Wellness and preventive services
that are provided or reimbursed at a lesser copayment,
coinsurance, or other cost sharing than other medical and
surgical services are excluded from this comparison; and
(ii) Prescription drugs intended to treat any of the
disorders covered in subsection (1) of this section to the same
extent, and under the same terms and conditions, as other
prescription drugs covered by the health benefit plan.
(b) For all health benefit plans established or renewed on
or after January 1, 2008, coverage for:
(i) Mental health services. The copayment or coinsurance
for mental health services may be no more than the copayment or
coinsurance for medical and surgical services otherwise provided
under the health benefit plan. Wellness and preventive services
that are provided or reimbursed at a lesser copayment,
coinsurance, or other cost sharing than other medical and
surgical services are excluded from this comparison. If the
health benefit plan imposes a maximum out-of-pocket limit or stop
loss, it shall be a single limit or stop loss for medical,
surgical, and mental health services; and
(ii) Prescription drugs intended to treat any of the
disorders covered in subsection (1) of this section to the same
extent, and under the same terms and conditions, as other
prescription drugs covered by the health benefit plan.
(c) For all health benefit plans established or renewed on
or after July 1, 2010, coverage for:
(i) Mental health services. The copayment or coinsurance
for mental health services may be no more than the copayment or
coinsurance for medical and surgical services otherwise provided
under the health benefit plan. Wellness and preventive services
that are provided or reimbursed at a lesser copayment,
coinsurance, or other cost sharing than other medical and
surgical services are excluded from this comparison. If the
health benefit plan imposes a maximum out-of-pocket limit or stop
loss, it shall be a single limit or stop loss for medical,
surgical, and mental health services. If the health benefit plan
imposes any deductible, mental health services shall be included
with medical and surgical services for the purpose of meeting the
deductible requirement. Treatment limitations or any other
financial requirements on coverage for mental health services are
only allowed if the same limitations or requirements are imposed
on coverage for medical and surgical services; and
(ii) Prescription drugs intended to treat any of the
disorders covered in subsection (1) of this section to the same
extent, and under the same terms and conditions, as other
prescription drugs covered by the health benefit plan.
(3) In meeting the requirements of subsection (2)(a) and (b)
of this section, health benefit plans may not reduce the number
of mental health outpatient visits or mental health inpatient
days below the level in effect on July 1, 2002.
(4) This section does not prohibit a requirement that mental
health services be medically necessary as determined by the
medical director or designee, if a comparable requirement is
applicable to medical and surgical services.
(5) Nothing in this section shall be construed to prevent
the management of mental health services.
(6) The administrator will consider care management
techniques for mental health services, including but not limited
to: (a) Authorized treatment plans; (b) preauthorization
requirements based on the type of service; (c) concurrent and
retrospective utilization review; (d) utilization management
practices; (e) discharge coordination and planning; and (f)
contracting with and using a network of participating providers.
[2005 c 6 § 2.]
NOTES:
Findings -- Intent -- 2005 c 6: "The legislature finds that the
costs of leaving mental disorders untreated or undertreated are
significant, and often include: Decreased job productivity, loss
of employment, increased disability costs, deteriorating school
performance, increased use of other health services, treatment
delays leading to more costly treatments, suicide, family
breakdown and impoverishment, and institutionalization, whether
in hospitals, juvenile detention, jails, or prisons.
Treatable mental disorders are prevalent and often have a
high impact on health and productive life. The legislature finds
that the potential benefits of improved access to mental health
services are significant. Additionally, the legislature declares
that it is not cost-effective to treat persons with mental
disorders differently than persons with medical and surgical
disorders.
Therefore, the legislature intends to require that insurance
coverage be at parity for mental health services, which means
this coverage be delivered under the same terms and conditions as
medical and surgical services." [2005 c 6 § 1.]
Severability -- 2005 c 6: "If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected." [2005 c 6 § 13.]