376.810. Definitions for policy requirements for chemical dependency.
Definitions for policy requirements for chemical dependency.
376.810. As used in sections 376.810 to 376.814, the following termsmean:
(1) "Chemical dependency", the psychological or physiologicaldependence upon and abuse of drugs, including alcohol, characterized bydrug tolerance or withdrawal and impairment of social or occupational rolefunctioning or both;
(2) "Community mental health center", a legal entity certified by thedepartment of mental health or accredited by a nationally recognizedorganization, through which a comprehensive array of mental health servicesare provided to individuals;
(3) "Day program services", a structured, intensive day or eveningtreatment or partial hospitalization program, certified by the departmentof mental health or accredited by a nationally recognized organization;
(4) "Episode", a distinct course of chemical dependency treatmentseparated by at least thirty days without treatment;
(5) "Health insurance policy", all health insurance policies orcontracts that are individually underwritten or provide such coverage forspecific individuals and members of their families, which provide forhospital treatment. For the purposes of subsection 2 of section 376.811,"health insurance policy" shall also include any individually underwrittencoverage issued by a health maintenance organization. The provisions ofsections 376.810 to 376.814 shall not apply to policies which providecoverage for a specified disease only, other than for mental illness orchemical dependency;
(6) "Licensed professional", a licensed physician specializing in thetreatment of mental illness, a licensed psychologist, a licensed clinicalsocial worker or a licensed professional counselor. Only prescriptionrights under this act shall apply to medical physicians and doctors ofosteopathy;
(7) "Managed care", the determination of availability of coverageunder a health insurance policy through the use of clinical standards todetermine the medical necessity of an admission or treatment, and the leveland type of treatment, and appropriate setting for treatment, with requiredauthorization on a prospective, concurrent or retrospective basis,sometimes involving case management;
(8) "Medical detoxification", hospital inpatient or residentialmedical care to ameliorate acute medical conditions associated withchemical dependency;
(9) "Nonresidential treatment program", a* program certified by thedepartment of mental health involving structured, intensive treatment in anonresidential setting;
(10) "Recognized mental illness", those conditions classified as"mental disorders" in the American Psychiatric Association Diagnostic andStatistical Manual of Mental Disorders, but shall not include mentalretardation;
(11) "Residential treatment program", a* program certified by thedepartment of mental health involving residential care and structured,intensive treatment;
(12) "Social setting detoxification", a program in a supportivenonhospital setting designed to achieve detoxification, without the use ofdrugs or other medical intervention, to establish a plan of treatment andprovide for medical referral when necessary.
(L. 1991 S.B. 352 § 7 subsec. 1, A.L. 1997 H.B. 335, A.L. 1999 H.B. 191, A.L. 2004 H.B. 855)*Word "a" does not appear in original rolls.