L2889.01T

To repeal section 376.381, RSMo 1994, relating to mental health expense benefits, and to enact in lieu thereof one new section relating to the same subject.

Be it enacted by the General Assembly of the State of Missouri, as follows:

Section A. Section 376.381, RSMo 1994, is repealed and one new section enacted in lieu thereof, to be known as section 376.381, to read as follows:

376.381. 1. For purposes of sections 376.381 and 376.382, the term "recognized mental illness" shall include those conditions classified as "mental disorders" in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, but shall not include mental retardation.

2. After August [13, 1980] 28, 1996, every insurance company, health services corporation and health maintenance organization doing business in Missouri shall offer to each policyholder or contract holder of a medical expense policy or contract coverage for expenses arising from psychiatric services for a recognized mental illness and professional counseling as defined by section 337.500, RSMo, which coverage shall at least meet the following minimum requirements:

(1) In the case of policies or contracts which provide benefits for expenses as an inpatient in a general hospital, benefits for inpatient treatment for a recognized mental illness shall be the same as for any other illness, except that benefits may be limited, but benefits shall be available for at least thirty days in any policy or contract benefit period;

(2) In the case of policies or contracts which provide benefits for outpatient expenses, benefits shall apply to the therapeutic care and treatment of a recognized mental illness when prescribed by a licensed physician specializing in the treatment of mental illness and rendered in a psychiatric residential treatment center accredited by the Joint Commission on Accreditation of Hospitals on either an inpatient or outpatient basis. Such benefits shall be payable within the terms of the policy or contract, notwithstanding the policy or contract definition of hospital, to the extent of not less than fifty percent of the reasonable and customary charges for such services and up to a maximum benefit of one thousand five hundred dollars during each policy or contract benefit period;

(3) In the case of policies or contracts which provide benefits for outpatient expenses, such benefits shall be provided to the extent of not less than fifty percent of reasonable and customary charges for twenty psychotherapy or professional counseling sessions during any policy or contract benefit period for psychiatric services for a recognized mental illness rendered by a licensed physician specializing in the treatment of mental illness. Such benefits shall also apply to such services when rendered by a licensed psychologist [or], licensed professional counselor or licensed clinical social worker, unless specifically rejected by the group or individual policyholder or contract holder. The frequency of such psychotherapy sessions may be limited, but benefits shall be available for at least one session during any seven consecutive days.