Medical Necessity Determination Insurance Coverage

Document status changed from Rerevised to Revised, indicating procedural progression in the legislative process.

New section numbering added (sections 26 and 27) with the beginning of a new provision regarding utilization review criteria for behavioral health services.

Senate sponsorship list was removed from the document header, likely due to procedural changes in the legislative process.

Added multiple new co-sponsors to the House and Senate sponsorship lists, expanding bipartisan support for the bill.

Minor formatting and section numbering adjustments were made to align with the revised version, including adding references to subsection (5.5)(b) and (5.5)(e).

Text was consolidated and reorganized to remove redundant language while preserving the core requirements for mental health and substance use disorder coverage.

Updated utilization review criteria for mental health disorders to require alignment with American Academy of Child and Adolescent Psychiatry and American Association for Community Psychiatry standards, replacing previous broader language about unaffiliated associations.

Added specific requirements for age-appropriate level-of-care and service intensity criteria for children and adolescents, referencing specialized utilization systems for pediatric mental health care.

Reorganized and clarified the structure of mandatory coverage provisions to better distinguish between different types of utilization review requirements and their corresponding criteria sources.

Added explicit requirement that health benefit plans must authorize placement at service intensity and level of care consistent with relevant criteria when a healthcare provider has completed an assessment.

Modified language regarding substance use disorder criteria to allow commissioners to identify alternate nationally recognized criteria if ASAM criteria are no longer available or relevant.

Updated references to federal regulations from 2013 to include a 2024 regulation, ensuring compliance with current federal standards for mental health coverage.

Corrected a reference in utilization review criteria from subsection (5.5)(a)(I.5)(13) to (5.5)(a)(I.5)(B), clarifying which rules apply to service intensity and level of care decisions.

Added administrative language indicating the bill is prepared for signatures and includes a note about checking legislative status.

Removed a provision requiring health plans to establish procedures for treating patients at nonparticipating providers, which appears to have been deleted from the final version.

Added new sponsors to the bill, including additional representatives and senators who support the legislation.

Modified utilization review criteria language to clarify that plans must use nationally recognized standards for behavioral health services.

Added new requirement that health plans cannot limit chronic behavioral health coverage to short-term symptom reduction.

Added new requirement for plans to establish procedures for accessing medically necessary services from non-participating providers.

Modified references to clinical specialty associations to ensure alignment with current nationally recognized standards.

Added new co-sponsors to the House sponsorship list, expanding the number of legislators supporting the bill.

Updated the document header to reflect the bill is now 'Reengrossed' and includes amendments adopted on February 10, 2025.

Removed a provision that required health benefit plans to apply the same utilization review criteria as specified in state law for service intensity and level of care placement decisions, potentially allowing plans to use different or more restrictive criteria for these decisions.

Reorganized the statute to consolidate criteria for substance use disorders and behavioral health disorders into clearer subsections, removing redundant text about placement, admission, and discharge.

Added new subsection (I.5)(B) that explicitly prohibits health benefit plans from applying different, additional, conflicting, or more restrictive utilization review criteria than those set forth in nationally recognized standards.

Updated section references and formatting throughout the bill to align with the new structure, including adding a new subsection (5.5)(e) to the list of amended statutes.