§ 12-17.6-4-2 — Services covered; prohibition on treatment limitations or financial requirements; mental health services

Indiana § 12-17.6-4-2

• Jurisdiction: Indiana
• Art. 17.6: CHILDREN'S HEALTH INSURANCE
• Ch. 4: Benefits, Crowd Out, and Cost Sharing

Text

(a) The benefit package provided under the
program shall focus on age appropriate preventive, primary, and acute
care services.
(b) The office shall offer health insurance coverage for the following
basic services:
(1) Inpatient and outpatient hospital services.
(2) Physicians' services provided by a physician (as defined in 42
U.S.C. 1395x(r)).
(3) Laboratory and x-ray services.
(4) Well-baby and well-child care, including:
(A) age appropriate immunizations; and
(B) periodic screening, diagnosis, and treatment services
according to a schedule developed by the office.
The office may offer services in addition to those listed in this
subsection if appropriations to the program exist to pay for the
additional services.
(c) The office shall offer health insurance coverage for the following
additional services if the coverage for the services has an actuarial
value equal to or greater than the actuarial value of the services
provided by the benchmark program determined by the children's
health policy board established by IC 4-23-27-2:
(1) Prescription drugs.
(2) Mental health services.
(3) Vision services.
(4) Hearing services.
(5) Dental services.
(d) Notwithstanding subsections (b) and (c), the office may not
impose treatment limitations or financial requirements on the coverage
of services for a mental illness if similar treatment limitations or
financial requirements are not imposed on coverage for services for
other illnesses. Coverage for mental illness under the program must
include the following:
(1) Inpatient mental health services and substance abuse services
provided in an institution that:
(A) treats mental disease; and
(B) has more than sixteen (16) beds;
unless coverage is prohibited by federal law.
(2) Psychiatric residential treatment services.
(3) Community mental health rehabilitation services.
(4) Outpatient mental health services and substance abuse
services, with no greater limitations on the number of units per
rolling year than are required under the Medicaid program.
However, the office may require prior authorization for the services
specified in subdivisions (1) through (4).

Legislative History

As added by P.L.273-1999, SEC.177. Amended by P.L.103-2009, SEC.1.