§431M-3  Peer review.  (a) 
Covered benefits for alcohol dependence, drug dependence, or mental illness
insurance policies, hospital or medical service plan contracts, and health
maintenance organization health plan contracts shall be limited to those services
certified by the insurance or health care plan carrier's physician,
psychologist, licensed clinical social worker, marriage and family therapist,
licensed mental health counselor, or advanced practice registered nurse as
medically or psychologically necessary at the least restrictive appropriate
level of care.



(b)  All alcohol dependence, drug dependence,
or mental illness treatment or services as set forth in this chapter shall be
subject to peer review procedures as a condition of payment or reimbursement,
to assure that reimbursement is limited to appropriate utilization under
criteria incorporated into insurance policies or health or service plan
contracts either directly or by reference.  Review may involve prior approval,
concurrent review of the continuation of treatment, post-treatment review or
any combination of these.  However, if prior approval is required, provision
shall be made to allow for payment of urgent or emergency admissions, subject
to subsequent review. [L 1988, c 202, pt of §1, §3; am L 1994, c 111, §4; am L
1997, c 247, §2 and c 273, §2; am L 1998, c 78, §3; am L 2002, c 167, §4 and c
239, §1; am L 2007, c 38, §2; am L 2008, c 206, §3]