376.827. Requirements for mental illness coverage--parity with coverage provided for physical conditions. - Missouri Statutes

Requirements for mental illness coverage--parity with coverageprovided for physical conditions.

376.827. 1. Nothing in this bill* shall be construed as requiringthe coverage of mental illness.

2. Except for the coverage required pursuant to subsection 1 ofsection 376.779, and the offer of coverage required pursuant to sections376.810 through 376.814, if any of the mental illness disorders enumeratedin subdivision (4) of section 376.826 are provided by the health insurancepolicy, the coverage provided shall include all the disorders enumerated insubdivision (4) of section 376.826 and shall not establish any rate, term,or condition that places a greater financial burden on an insured foraccess to evaluation and treatment for mental illness than for access toevaluation and treatment for physical conditions, generally, except thatalcohol and other drug abuse services shall have a minimum of thirty daystotal inpatient treatment and a minimum of twenty total visits foroutpatient treatment for each year of coverage. A lifetime limit equal tofour times such annual limits may be imposed. The days allowed forinpatient treatment can be converted for use for outpatient treatment on atwo-for-one basis.

3. Deductibles, co-payment or coinsurance amounts for access toevaluation and treatment for mental illness shall not be unreasonable inrelation to the cost of services provided.

4. A health insurance policy that is a federally qualified plan ofbenefits shall be construed to be in compliance with sections 376.825 to376.836 if the policy is issued by a federally qualified health maintenanceorganization and the federally qualified health maintenance organizationoffered mental health coverage as required by sections 376.825 to 376.836.If such coverage is rejected, the federally qualified health maintenanceorganization shall, at a minimum, provide coverage for mental healthservices as a basic health service as required by the Federal Public HealthService Act, 42 U.S.C. Section 300e., et seq.

5. Health insurance policies that provide mental illness benefitspursuant to sections 376.825 to 376.840 shall be deemed to be in compliancewith the requirements of subsection 1 of section 376.779.

6. The director may disapprove any policy that the directordetermines to be inconsistent with the purposes of this section.

(L. 1999 H.B. 191)

Expires 1-01-11

*"This bill" (H.B. 191, 1999) contains numerous sections. Consult Disposition of Sections table for definitive listing.