376.830. Services administered and delivered by whom--contracted services permitted, when. - Missouri Statutes

Services administered and delivered by whom--contracted servicespermitted, when.

376.830. 1. The coverages set forth in sections 376.825 to 376.840may be administered pursuant to a managed care program established by theinsurance company, health services corporation or health maintenanceorganization, and covered services may be delivered through a system ofcontractual arrangements with one or more licensed providers, communitymental health centers, hospitals, nonresidential or residential treatmentprograms, or other mental health service delivery entities certified by thedepartment of mental health, or accredited by a nationally recognizedorganization, or licensed by the state of Missouri. Nothing in thissection shall authorize any unlicensed provider to provide coveredservices.

2. An insurer may use a case management program for mental illnessbenefits to evaluate and determine medically necessary and clinicallyappropriate care and treatment for each patient.

3. Nothing in sections 376.825 to 376.840 shall be construed torequire a managed care plan as defined by section 354.600, RSMo, whenproviding coverage for benefits governed by sections 376.825 to 376.840, tocover services rendered by a provider other than a participating provider,except for the coverage pursuant to subsection 4 of section 376.811. Aninsurer may contract for benefits provided in sections 376.825 to 376.840with a managing entity or group of providers for the management anddelivery of services for benefits governed by sections 376.825 to 376.840.

(L. 1999 H.B. 191 § 376.828)

Expires 1-01-11