1.
Notwithstanding any provision of a health insurance policy subject to this chapter,
whenever the policy provides for payment or reimbursement for services that are within
the lawful scope of practice of a professional listed in subsection 2-A, any person
covered by the policy is entitled to reimbursement for these services if the services
are performed by a physician or a professional listed in subsection 2-A. Payment
or reimbursement for services rendered by a professional listed in subsection 2-A,
paragraph B, C, D, E or F may not be conditioned upon prior diagnosis or referral
by a physician or other health care professional, except when diagnosis of the condition
for which the services are rendered is beyond the scope of their licensure.
[
2005, c. 683, Pt. A, §39 (RPR)
.]
2.
Nothing in subsection 1 may be construed to require a health insurance policy subject
to this chapter to provide for reimbursement of services that are within the lawful
scope of practice of a professional listed in subsection 2-A.
[
2005, c. 683, Pt. A, §39 (RPR)
.]
2-A.
Subsections 1 and 2 apply with respect to the following types of professionals:
A. A psychologist licensed to practice in this State; [2005, c. 683, Pt. A, §39 (RPR).]
B. A certified social worker licensed for the independent practice of social work in
this State; [2005, c. 683, Pt. A, §39 (RPR).]
C. A licensed clinical professional counselor licensed for the independent practice
of counseling in this State; [2005, c. 683, Pt. A, §39 (RPR).]
D. A licensed nurse who is certified by the American Nurses' Association as a clinical
specialist in adult psychiatric and mental health nursing or as a clinical specialist
in child and adolescent psychiatric and mental health nursing; [2005, c. 683, Pt. A, §39 (RPR).]
E. A marriage and family therapist licensed as a marriage and family therapist in this
State; and [2005, c. 683, Pt. A, §39 (NEW).]
F. A licensed pastoral counselor licensed as a pastoral counselor in this State. [2005, c. 683, Pt. A, §39 (NEW).]
[
2005, c. 683, Pt. A, §39 (RPR)
.]
3.Mental health services provided by counseling professionals.
Except as provided in subsection 1 with regard to reimbursement of clinical professional
counselors, pastoral counselors and marriage and family therapists licensed in this
State, an insurer that issues individual health care contracts providing coverage
for mental health services shall offer coverage for those services when performed
by a counseling professional who is licensed by the State pursuant to Title 32, chapter
119 to assess and treat interpersonal and intrapersonal problems, has at least a master's
degree in counseling or a related field from an accredited educational institution
and has been employed as a counselor for at least 2 years. Any contract providing
coverage for the services of counseling professionals pursuant to this section may
be subject to any reasonable limitations, maximum benefits, coinsurance, deductibles
or exclusion provisions applicable to overall benefits under the contract. This subsection
applies to all contracts executed, delivered, issued for delivery, continued or renewed
in this State on or after January 1, 1997. For purposes of this subsection, all contracts
are deemed renewed no later than the next yearly anniversary of the contract date.
[
2005, c. 683, Pt. A, §39 (RPR)
.]
SECTION HISTORY
1975, c. 770, §104 (NEW).
1983, c. 546, §2 (AMD).
1983, c. 805, §2 (AMD).
1987, c. 80, §2 (AMD).
1995, c. 561, §2 (AMD).
2003, c. 65, §1 (AMD).
2003, c. 65, §5 (AFF).
2005, c. 121, §§I1,2 (AMD).
2005, c. 213, §1 (AMD).
2005, c. 213, §3 (AFF).
2005, c. 214, §1 (AMD).
2005, c. 214, §3 (AFF).
2005, c. 683, §A39 (RPR).
Data for this page extracted on 01/05/2015 12:11:17.