44-794. Mental health conditions; sections; how construed.

(1) Sections 44-791 to 44-795 shall not be construed to:

(a) Require a health insurance plan to provide coverage for mental health conditions or serious mental illnesses;

(b) Require a health insurance plan to provide the same rates, terms, or conditions between treatments for serious mental illnesses and preventative care;

(c) Prohibit a health insurance plan from providing separate reimbursement rates and service delivery systems, including, but not limited to, mental health carve-out programs even if the plan does not provide similar options for the treatment of physical health conditions. A health insurance plan provided in compliance with section 44-793 shall not be construed to violate the Managed Care Plan Network Adequacy Act; or

(d) Prohibit a health insurance plan from managing the provision of benefits through common methods, including, but not limited to, preadmission screening, prior authorization of services, or other mechanisms designed to limit coverage to services for mental health conditions that are deemed to be medically necessary and clinically appropriate.

(2) A health insurance plan does not violate section 44-793 if the plan applies different rates, terms, and conditions or excludes entirely from coverage the following:

(a) Marital, family, educational, developmental, or training services;

(b) Care that is substantially custodial in nature;

(c) Services and supplies that are not medically necessary or clinically appropriate; or

(d) Experimental treatments.

(3) A health insurance plan may use a case management program or managed care organization to evaluate, determine, and provide or arrange for medically necessary and clinically appropriate care and treatment of each person with a mental health condition or serious mental illness who is covered by the plan.

(4) A health insurance plan shall not be required to offer coverage for nonemergency services rendered outside its network of contracted providers.

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