§2842. Equitable health care for alcoholism and drug dependency treatment
1.Purpose.
The Legislature recognizes that alcoholism and drug dependency constitute major health problems in the State and in the Nation.
The Legislature further recognizes that alcoholism is a disease and that alcoholism and drug dependency can be effectively
treated. As such, alcoholism and drug dependency warrant the same attention from the health care industry as other serious
diseases and illnesses. The Legislature further recognizes that health insurance contracts, at times, fail to provide adequate
benefits for the treatment of alcoholism and drug dependency, which results in more costly health care for treatment of complications
caused by the lack of early intervention and other treatment services for persons suffering from these illnesses. This situation
causes a higher health care, social, law enforcement and economic cost to the citizens of this State than is necessary, including
the need for the State to provide treatment to some insureds at public expense. To assist the many citizens of this State
who suffer from these illnesses in a more cost effective way, the Legislature declares that certain health insurance coverage
providing benefits for the treatment of the illness of alcoholism and drug dependency shall be included in all group health
insurance contracts.
[
1983, c. 527, §2 (RPR)
.]
2.Definitions.
As used in this section, unless the context indicates otherwise, the following terms have the following meanings.
A. "Outpatient care" means care rendered by a state-licensed, approved or certified detoxification, residential treatment or
outpatient program, or partial hospitalization program on a periodic basis, including, but not limited to, patient diagnosis,
assessment and treatment, individual, family and group counseling and educational and support services. [1983, c. 527, §2 (NEW).]
B. "Residential treatment" means services at a facility that provides care 24 hours daily to one or more patients, including,
but not limited to, the following services: Room and board; medical, nursing and dietary services; patient diagnosis, assessment
and treatment; individual, family and group counseling; and educational and support services, including a designated unit
of a licensed health care facility providing any and all other services specified in this paragraph to patients with the illnesses
of alcoholism and drug dependency. [1983, c. 527, §2 (NEW).]
C. "Treatment plan" means a written plan initiated at the time of admission, approved by a Doctor of Medicine, Doctor of Osteopathy
or a Registered Substance Abuse Counselor employed by a certified or licensed substance abuse program, including, but not
limited to, the patient's medical, drug and alcoholism history; record of physical examination; diagnosis; assessment of physical
capabilities; mental capacity; orders for medication, diet and special needs for the patient's health or safety and treatment,
including medical, psychiatric, psychological, social services, individual, family and group counseling; and educational,
support and referral services. [1983, c. 527, §2 (NEW).]
[
1983, c. 527, §2 (RPR)
.]
3.Requirement.
Every insurer which issues group health care contracts providing coverage for hospital care to residents of this State shall
provide benefits as required in this section to any subscriber or other person covered under those contracts for the treatment
of alcoholism and other drug dependency pursuant to a treatment plan.
[
1983, c. 527, §2 (NEW)
.]
4.Services; providers.
Each group contract shall provide, at a minimum, for the following coverage, pursuant to a treatment plan:
A. Residential treatment at a hospital or free-standing residential treatment center which is licensed, certified or approved
by the State; and [1983, c. 527, §2 (NEW).]
B. Outpatient care rendered by state licensed, certified or approved providers. [1983, c. 527, §2 (NEW).]
Treatment or confinement at any facility shall not preclude further or additional treatment at any other eligible facility,
provided that the benefit days used do not exceed the total number of benefit days provided for under the contract.
[
1983, c. 527, §2 (NEW)
.]
5.Exceptions.
This section shall not apply to employee group insurance policies issued to employers with 20 or fewer employees insured
under the group policy or to group policies designed primarily to supplement the Civilian Health and Medical Program of the
Uniformed Services, as described in Title 10 of the United States Code, Title 10, Section 1072, subsection 4.
[
1989, c. 490, §3 (AMD)
.]
6.Limits; coinsurance; deductibles.
Any policy or contract which provides coverage for the services required by this section may contain provisions for maximum
benefits and coinsurance, and reasonable limitations, deductibles and exclusions to the extent that these provisions are not
inconsistent with the requirements of this section.
[
1983, c. 527, §2 (NEW)
.]
7.Notice.
At the time of delivery or renewal, the group health insurer shall provide written notification to all individuals eligible
for benefits under group policies or contracts of these alcoholism and drug dependency benefits.
[
1983, c. 527, §2 (NEW)
.]
8.Confidentiality.
Alcoholism and drug treatment patient records are confidential.
[
2011, c. 320, Pt. A, §10 (AMD)
.]
9.Reports to the Superintendent of Insurance.
Every insurer subject to this section shall report its experience for each calendar year beginning with 1984 to the superintendent
not later than April 30th of the following year. The report shall be in a form prescribed by the superintendent and shall
include the amount of claims paid in this State for the services required by this section and the total amount of claims paid
in this State for group health care contracts, both separated between those paid for inpatient and outpatient services. The
superintendent shall compile this data for all insurers in an annual report.
[
1983, c. 527, §2 (NEW)
.]
10.Application; expiration.
The requirements of this section shall apply to all policies and any certificates or contracts executed, delivered, issued
for delivery, continued or renewed in this State on or after January 1, 1984. For purposes of this section, all contracts
shall be deemed to be renewed no later than the next yearly anniversary of the contract date.
[
1987, c. 480, §5 (RPR)
.]
SECTION HISTORY
1981, c. 319, §§2,3 (NEW).
1983, c. 527, §2 (RPR).
1987, c. 480, §5 (AMD).
1989, c. 490, §3 (AMD).
2011, c. 320, Pt. A, §10 (AMD).
Data for this page extracted on 10/16/2012 08:29:52.