33-22-705. Inpatient and outpatient benefits -- use of psychiatric collaborative care or primary care behavioral health model. (1) (a) Inpatient benefits are benefits payable for charges made by:
(i) a hospital or freestanding inpatient facility for the necessary care and treatment of mental illness, severe mental illness, or substance use disorder furnished to a covered person while confined as an inpatient; or
(ii) a qualified health care provider for the necessary care and treatment of mental illness, severe mental illness, or substance use disorder furnished to a covered person while confined as an inpatient.
(b) Care and treatment of a substance use disorder in a freestanding inpatient facility must be in a substance use disorder treatment center.
(c) Inpatient benefits include payment for medically monitored and medically managed intensive inpatient services and clinically managed high-intensity residential services.
(2) Outpatient benefits are benefits payable for:
(a) reasonable charges made by a hospital for the necessary care and treatment of mental illness, severe mental illness, or substance use disorder furnished to a covered person while not confined as an inpatient;
(b) reasonable charges for services rendered or prescribed by a qualified health care provider for the necessary care and treatment for mental illness, severe mental illness, or substance use disorder furnished to a covered person while not confined as an inpatient;
(c) reasonable charges made by a mental health or substance use disorder treatment center for the necessary care and treatment of a covered person provided in the treatment center while not confined as an inpatient;
(d) reasonable charges for services rendered by a qualified health care provider, hospital, mental health treatment center, or substance use disorder treatment center in an acute or subacute partial hospitalization or intensive outpatient treatment setting; or
(e) reasonable charges for outpatient benefits listed in this subsection (2) that are delivered through the psychiatric collaborative care model or primary care behavioral health model. The charges must be reimbursed through the use of the following common procedural terminology billing codes established by the American medical association:
(i) 99492;
(ii) 99493;
(iii) 99494;
(iv) 99484, the code for care management services for behavioral health conditions;
(v) 96156, 96158, 96159, 96164, 96165, 96167, 96168, 96170, and 96171, the codes for health behavior assessment and intervention; and
(vi) 99446, 99447, 99448, 99449, and 99451, the codes for interprofessional telephone/internet/electronic health record consultations.
History: En. Sec. 1, Ch. 98, L. 1987; amd. Sec. 12, Ch. 606, L. 1987; amd. Sec. 1, Ch. 262, L. 1991; amd. Sec. 84, Ch. 546, L. 1995; amd. Sec. 11, Ch. 507, L. 1997; amd. Sec. 2, Ch. 477, L. 1999; amd. Sec. 2, Ch. 23, L. 2001; amd. Sec. 105, Ch. 483, L. 2001; amd. Sec. 5, Ch. 245, L. 2017; amd. Sec. 3, Ch. 277, L. 2021.