§ 23-99-508 — Permitted provisions

(a) A healthcare insurer may at the healthcare insurer's option provide coverage for a health service, such as intensive case management, community residential treatment programs, or social rehabilitation programs, that is used in the treatment of mental illnesses but is generally not used for other injuries, illnesses, and conditions if the other requirements of this subchapter are met. (b) Healthcare insurers providing educational remediation may, but are not required to, comply with the terms of this subchapter in regard to the treatment or remediation. (c) A healthcare insurer may provide coverage for a health service, including without limitation physical rehabilitation or durable medical equipment, which generally is not used in the diagnosis or treatment of serious mental illnesses but is used for other injuries, illnesses, and conditions if the other requirements of this subchapter are met. (d) A healthcare insurer may utilize common utilization management protocols, including without limitation preadmission screening, prior authorization of service, or other mechanisms designed to limit coverage of service for mental illness to individuals whose diagnosis or treatment coverage is considered medically necessary although the protocols are not used in conjunction with other medical illnesses or conditions covered by the health benefit plan.

Legislative History

Acts 1997, No. 1020, § 6; 2009, No. 1193, § 9.