Section 376.779

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 376

Effective - 28 Aug 2004   

  376.779.  Health insurance policies to offer coverage for treatment of alcoholism — exclusions. — 1.  All health plans or policies that are individually underwritten or provide for such coverage for specific individuals and the members of their families, which provide for hospital treatment, shall provide coverage, while confined in a hospital or in a residential or nonresidential facility certified by the department of mental health, for treatment of alcoholism on the same basis as coverage for any other illness, except that coverage may be limited to thirty days in any policy or contract benefit period.  All Missouri individual contracts issued on or after January 1, 2005, shall be subject to this section.  Coverage required by this section shall be included in the policy or contract and payment provided as for other coverage in the same policy or contract notwithstanding any construction or relationship of interdependent contracts or plans affecting coverage and payment of reimbursement prerequisites under the policy or contract.

  2.  Insurers, corporations or groups providing coverage may approve for payment or reimbursement vendors and programs providing services or treatment required by this section.  Any vendor or person offering services or treatment subject to the provisions of this section and seeking approval for payment or reimbursement shall submit to the department of mental health a detailed description of the services or treatment program to be offered.  The department of mental health shall make copies of such descriptions available to insurers, corporations or groups providing coverage under the provisions of this section.  Each insurer, corporation or group providing coverage shall notify the vendor or person offering service or treatment as to its acceptance or rejection for payment or reimbursement; provided, however, payment or reimbursement shall be made for any service or treatment program certified by the department of mental health.  Any notice of rejection shall contain a detailed statement of the reasons for rejection and the steps and procedures necessary for acceptance.  Amended descriptions of services or treatment programs to be offered may be filed with the department of mental health.  Any vendor or person rejected for approval of payment or reimbursement may modify their description and treatment program and submit copies of the amended description to the department of mental health and to the insurer, corporation or group which rejected the original description.

  3.  The department of mental health may issue rules necessary to carry out the provisions of this section.  No rule or portion of a rule promulgated under the authority of this section shall become effective unless it has been promulgated pursuant to the provisions of section 536.024.

  4.  All substance abuse treatment programs in Missouri receiving funding from the Missouri department of mental health must be certified by the department.

  5.  This section shall not apply to a supplemental insurance policy, including a life care contract, accident-only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy, long-term care policy, hospitalization-surgical care policy, short-term major medical policy of six months or less duration, or any other supplemental policy as determined by the director of the department of commerce and insurance.

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(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)