§ 20-3504 — Access to behavioral health services for minors

A. Notwithstanding any other provision of this title, any health care insurer that issues a health plan in this state that includes mental health or substance use disorder benefits may not deny any claim for mental health or substance use disorder benefits for a minor solely on grounds that the mental health or substance use disorder service was provided in a school or other educational setting or ordered by a court if the service was provided by an in-network provider or by an out-of-network provider only as allowed by the health plan that covers the subscriber, enrollee or insured.

B. This section does not require a health care insurer to approve a claim or provide reimbursement for a mental health or substance use disorder service provided by an out-of-network provider except as allowed by the health plan that covers the subscriber, enrollee or insured.

C. A health care insurer may require that any mental health or substance use disorder service offered by a mental health provider in an educational setting be provided in a facility or location that is appropriate for the type of service provided and in a manner that complies with applicable laws governing the provision of health care services, including privacy and parental consent laws.

D. Claims for covered mental health or substance use disorder services that are provided by an out-of-network provider and that are not covered by the subscriber's, enrollee's or insured's health plan solely because the provider is an out-of-network provider shall be paid from the children's behavioral health services fund established by section 36-3436.