AI-assisted research summary: Some health coverage plans must cover mental health and substance abuse services delivered through evidence-based integrated behavioral care models, and their medical necessity determinations must comply with specified laws.
§1066.2. Psychiatric Collaborative Care Model; service delivery method requirements A. A health coverage plan which is delivered or issued for delivery in this state that provides mental health and substance abuse benefits shall provide coverage for mental health and substance abuse services that are delivered through evidence-based, integrated behavioral healthcare models, such as the Psychiatric Collaborative Care Model. B. Any medical necessity determination made by a health coverage plan shall be in compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and its related regulations, and in accordance with the Internal Claims and Appeals Process and External Review Act, R.S. 22:2391 et seq. C. As used in this Section, the following terms apply: (1) "Health coverage plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract or agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type, including a group insurance plan and the Office of Group Benefits programs. (2) "Mental health or substance abuse benefits" means benefits for the treatment of any condition or disorder that involves a mental health condition or substance use disorder that falls under any of the diagnostic categories listed in the mental disorders section of the current edition of the International Classification of Diseases or that is listed in the mental disorders section of the most recent version of the Diagnostic and Statistical Manual of Mental Disorders. (3) "Psychiatric Collaborative Care Model" means the evidence-based, integrated behavioral health service delivery method that is typically provided by a primary care team consisting of a primary care provider and a care manager who works in collaboration with a psychiatric consultant, such as a psychiatrist. Care is directed by the primary care team and includes structured care management with regular assessments of clinical status using validated tools and modification of treatment as appropriate. The psychiatric consultant provides regular consultations to the primary care team to review the clinical status and care of patients and to make recommendations. Acts 2022, No. 457, §1.