§431M-3  Peer review.  (a) Covered benefits for alcohol dependence, drug dependence, or mental illnessinsurance policies, hospital or medical service plan contracts, and healthmaintenance organization health plan contracts shall be limited to those servicescertified 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 asmedically or psychologically necessary at the least restrictive appropriatelevel of care.

(b)  All alcohol dependence, drug dependence,or mental illness treatment or services as set forth in this chapter shall besubject to peer review procedures as a condition of payment or reimbursement,to assure that reimbursement is limited to appropriate utilization undercriteria incorporated into insurance policies or health or service plancontracts either directly or by reference.  Review may involve prior approval,concurrent review of the continuation of treatment, post-treatment review orany combination of these.  However, if prior approval is required, provisionshall be made to allow for payment of urgent or emergency admissions, subjectto subsequent review. [L 1988, c 202, pt of §1, §3; am L 1994, c 111, §4; am L1997, c 247, §2 and c 273, §2; am L 1998, c 78, §3; am L 2002, c 167, §4 and c239, §1; am L 2007, c 38, §2; am L 2008, c 206, §3]