40-2,105.Insurance coverageunder individual or small employer group policies for services rendered intreatment ofmental illness, alcoholism, drug abuse or substance use disorders; limitations;exceptions.(a) On or after the effective date of this act, every insurer which issuesany individual policy of accident and sickness insurance or group policyof accident and sickness insurance to a small employer asdefined in K.S.A. 40-2209d, and amendments thereto, which provides medical,surgical or hospital expense coverage for other than specificdiseases or accidents only and which provides for reimbursement orindemnity for services rendered to a person covered by such policy in amedical care facility, must provide for reimbursement or indemnity undersuch individual policy or under such small employer group policy, exceptas provided insubsection (d), which shall be limited to not less than 45days per yearfor in-patient treatment of mentalillness in a medical care facility licensed under theprovisions of K.S.A. 65-429, and amendments thereto, and not lessthan 30days per year when such person is confined for treatment of alcoholism, drugabuse or substance use disorders in a treatment facilityfor alcoholics licensed under the provisions of K.S.A. 65-4014, andamendments thereto, a treatment facility for drug abusers licensed underthe provisions of K.S.A. 65-4605, and amendments thereto, a communitymentalhealth center or clinic licensed under the provisions of K.S.A.75-3307b,and amendments thereto, or a psychiatric hospital licensed under theprovisions of K.S.A. 75-3307b, and amendments thereto. Such individualpolicy or such small employer group policy shall also provide forreimbursement orindemnity, except as provided in subsection (d), of the costs of treatmentof such person for mental illness, alcoholism, drug abuse andsubstance use disorders subject to the samedeductibles, copayments, coinsurance, out-of-pocket expenses and treatmentlimitations as apply toother covered services,limited to not less than$15,000 insuch person's lifetime, with no annual limits, in the facilitiesenumerated when in-patient treatment isnot necessary for the treatment or by a physician licensed or psychologistlicensed to practice under the laws of the state of Kansas.
(b) For the purposes of this section"mental illness, alcoholism, drug abuse or substance use" meansdisorders specified in the diagnostic and statistical manual of mentaldisorders, fourth edition, (DSM-IV, 1994)of the American psychiatric association.
(c) The provisions of this section shall be applicable to healthmaintenance organizations organized under article 32 of chapter 40 of theKansas Statutes Annotated.
(d) There shall be no coverage under the provisions of this section for anyassessment against any person required by a diversion agreement or by orderof a court to attend an alcohol and drug safety action program certifiedpursuant to K.S.A. 8-1008, and amendments thereto, or forevaluations anddiagnostic tests ordered or requested in connection with criminal actions,divorce, child custodyor child visitation proceedings.
(e) The provisions of this section shall not apply to any medicaresupplement policy of insurance, as defined by the commissioner of insuranceby rule and regulation.
(f) Treatment limitations include limits on the frequency of treatment,number of visits, days of coverage or other similar limits on the scope orduration of treatment.
(g) Utilization review for mental illness shall be consistent with provisionsin K.S.A. 40-22a01 through 40-22a12, and amendments thereto.
40-2,105.Insurance coverageunder individual or small employer group policies for services rendered intreatment ofmental illness, alcoholism, drug abuse or substance use disorders; limitations;exceptions.(a) On or after the effective date of this act, every insurer which issuesany individual policy of accident and sickness insurance or group policyof accident and sickness insurance to a small employer asdefined in K.S.A. 40-2209d, and amendments thereto, which provides medical,surgical or hospital expense coverage for other than specificdiseases or accidents only and which provides for reimbursement orindemnity for services rendered to a person covered by such policy in amedical care facility, must provide for reimbursement or indemnity undersuch individual policy or under such small employer group policy, exceptas provided insubsection (d), which shall be limited to not less than 45days per yearfor in-patient treatment of mentalillness in a medical care facility licensed under theprovisions of K.S.A. 65-429, and amendments thereto, and not lessthan 30days per year when such person is confined for treatment of alcoholism, drugabuse or substance use disorders in a treatment facilityfor alcoholics licensed under the provisions of K.S.A. 65-4014, andamendments thereto, a treatment facility for drug abusers licensed underthe provisions of K.S.A. 65-4605, and amendments thereto, a communitymentalhealth center or clinic licensed under the provisions of K.S.A.75-3307b,and amendments thereto, or a psychiatric hospital licensed under theprovisions of K.S.A. 75-3307b, and amendments thereto. Such individualpolicy or such small employer group policy shall also provide forreimbursement orindemnity, except as provided in subsection (d), of the costs of treatmentof such person for mental illness, alcoholism, drug abuse andsubstance use disorders subject to the samedeductibles, copayments, coinsurance, out-of-pocket expenses and treatmentlimitations as apply toother covered services,limited to not less than$15,000 insuch person's lifetime, with no annual limits, in the facilitiesenumerated when in-patient treatment isnot necessary for the treatment or by a physician licensed or psychologistlicensed to practice under the laws of the state of Kansas.
(b) For the purposes of this section"mental illness, alcoholism, drug abuse or substance use" meansdisorders specified in the diagnostic and statistical manual of mentaldisorders, fourth edition, (DSM-IV, 1994)of the American psychiatric association.
(c) The provisions of this section shall be applicable to healthmaintenance organizations organized under article 32 of chapter 40 of theKansas Statutes Annotated.
(d) There shall be no coverage under the provisions of this section for anyassessment against any person required by a diversion agreement or by orderof a court to attend an alcohol and drug safety action program certifiedpursuant to K.S.A. 8-1008, and amendments thereto, or forevaluations anddiagnostic tests ordered or requested in connection with criminal actions,divorce, child custodyor child visitation proceedings.
(e) The provisions of this section shall not apply to any medicaresupplement policy of insurance, as defined by the commissioner of insuranceby rule and regulation.
(f) Treatment limitations include limits on the frequency of treatment,number of visits, days of coverage or other similar limits on the scope orduration of treatment.
(g) Utilization review for mental illness shall be consistent with provisionsin K.S.A. 40-22a01 through 40-22a12, and amendments thereto.
40-2,105.Insurance coverageunder individual or small employer group policies for services rendered intreatment ofmental illness, alcoholism, drug abuse or substance use disorders; limitations;exceptions.(a) On or after the effective date of this act, every insurer which issuesany individual policy of accident and sickness insurance or group policyof accident and sickness insurance to a small employer asdefined in K.S.A. 40-2209d, and amendments thereto, which provides medical,surgical or hospital expense coverage for other than specificdiseases or accidents only and which provides for reimbursement orindemnity for services rendered to a person covered by such policy in amedical care facility, must provide for reimbursement or indemnity undersuch individual policy or under such small employer group policy, exceptas provided insubsection (d), which shall be limited to not less than 45days per yearfor in-patient treatment of mentalillness in a medical care facility licensed under theprovisions of K.S.A. 65-429, and amendments thereto, and not lessthan 30days per year when such person is confined for treatment of alcoholism, drugabuse or substance use disorders in a treatment facilityfor alcoholics licensed under the provisions of K.S.A. 65-4014, andamendments thereto, a treatment facility for drug abusers licensed underthe provisions of K.S.A. 65-4605, and amendments thereto, a communitymentalhealth center or clinic licensed under the provisions of K.S.A.75-3307b,and amendments thereto, or a psychiatric hospital licensed under theprovisions of K.S.A. 75-3307b, and amendments thereto. Such individualpolicy or such small employer group policy shall also provide forreimbursement orindemnity, except as provided in subsection (d), of the costs of treatmentof such person for mental illness, alcoholism, drug abuse andsubstance use disorders subject to the samedeductibles, copayments, coinsurance, out-of-pocket expenses and treatmentlimitations as apply toother covered services,limited to not less than$15,000 insuch person's lifetime, with no annual limits, in the facilitiesenumerated when in-patient treatment isnot necessary for the treatment or by a physician licensed or psychologistlicensed to practice under the laws of the state of Kansas.
(b) For the purposes of this section"mental illness, alcoholism, drug abuse or substance use" meansdisorders specified in the diagnostic and statistical manual of mentaldisorders, fourth edition, (DSM-IV, 1994)of the American psychiatric association.
(c) The provisions of this section shall be applicable to healthmaintenance organizations organized under article 32 of chapter 40 of theKansas Statutes Annotated.
(d) There shall be no coverage under the provisions of this section for anyassessment against any person required by a diversion agreement or by orderof a court to attend an alcohol and drug safety action program certifiedpursuant to K.S.A. 8-1008, and amendments thereto, or forevaluations anddiagnostic tests ordered or requested in connection with criminal actions,divorce, child custodyor child visitation proceedings.
(e) The provisions of this section shall not apply to any medicaresupplement policy of insurance, as defined by the commissioner of insuranceby rule and regulation.
(f) Treatment limitations include limits on the frequency of treatment,number of visits, days of coverage or other similar limits on the scope orduration of treatment.
(g) Utilization review for mental illness shall be consistent with provisionsin K.S.A. 40-22a01 through 40-22a12, and amendments thereto.
