376.779. Health insurance policies to offer coverage for treatment of alcoholism--exclusions.
Health insurance policies to offer coverage for treatment ofalcoholism--exclusions.
376.779. 1. All health plans or policies that are individuallyunderwritten or provide for such coverage for specific individuals and themembers of their families, which provide for hospital treatment, shall providecoverage, while confined in a hospital or in a residential or nonresidentialfacility certified by the department of mental health, for treatment ofalcoholism on the same basis as coverage for any other illness, except thatcoverage may be limited to thirty days in any policy or contract benefitperiod. All Missouri individual contracts issued on or after January 1, 2005,shall be subject to this section. Coverage required by this section shall beincluded in the policy or contract and payment provided as for other coveragein the same policy or contract notwithstanding any construction orrelationship of interdependent contracts or plans affecting coverage andpayment of reimbursement prerequisites under the policy or contract.
2. Insurers, corporations or groups providing coverage may approve forpayment or reimbursement vendors and programs providing services or treatmentrequired by this section. Any vendor or person offering services or treatmentsubject to the provisions of this section and seeking approval for payment orreimbursement shall submit to the department of mental health a detaileddescription of the services or treatment program to be offered. Thedepartment of mental health shall make copies of such descriptions availableto insurers, corporations or groups providing coverage under the provisions ofthis section. Each insurer, corporation or group providing coverage shallnotify the vendor or person offering service or treatment as to its acceptanceor rejection for payment or reimbursement; provided, however, payment orreimbursement shall be made for any service or treatment program certified bythe department of mental health. Any notice of rejection shall contain adetailed statement of the reasons for rejection and the steps and proceduresnecessary for acceptance. Amended descriptions of services or treatmentprograms to be offered may be filed with the department of mental health. Anyvendor or person rejected for approval of payment or reimbursement may modifytheir description and treatment program and submit copies of the amendeddescription to the department of mental health and to the insurer, corporationor group which rejected the original description.
3. The department of mental health may issue rules necessary to carryout the provisions of this section. No rule or portion of a rule promulgatedunder the authority of this section shall become effective unless it has beenpromulgated pursuant to the provisions of section 536.024, RSMo.
4. All substance abuse treatment programs in Missouri receiving fundingfrom the Missouri department of mental health must be certified by thedepartment.
5. This section shall not apply to a supplemental insurance policy,including a life care contract, accident-only policy, specified diseasepolicy, hospital policy providing a fixed daily benefit only, Medicaresupplement policy, long-term care policy, hospitalization-surgical carepolicy, short-term major medical policy of six months or less duration, or anyother supplemental policy as determined by the director of the department ofinsurance, financial institutions and professional registration.
(L. 1977 S.B. 322 § 1, A.L. 1980 S.B. 636 & 573, A.L. 1985 H.B. 623, A.L. 1995 S.B. 3, A.L. 1999 H.B. 191, A.L. 2004 H.B. 855)