23-86-113. Minimum benefits for mental illness in group accident and health insurance policies or subscriber's contracts — Definition.

23-86-113. Minimum benefits for mental illness in group accident and health insurance policies or subscriber's contracts — Definition. (a) Unless refused in writing, every group accident and health insurance policy or group contract of hospital and medical service corporations issued or renewed after July 1, 1983, providing hospitalization or medical benefits to Arkansas residents for conditions arising from mental illness shall provide the following minimum benefits on and after July 1, 1983: (1) In the case of benefits based upon confinement as an inpatient in a hospital, psychiatric hospital, or outpatient psychiatric center licensed by the Department of Health or a community mental health center certified by the Division of Aging, Adult, and Behavioral Health Services of the Department of Human Services, the benefits shall be as defined in subsection (b) of this section; (2)(A) In the case of benefits provided for partial hospitalization in a hospital, psychiatric hospital, or outpatient psychiatric center licensed by the department or a community mental health center certified by the division as defined in subsection (b) of this section. (B) For the purpose of this section, “partial hospitalization” means continuous treatment for at least four (4) hours, but not more than sixteen (16) hours in any twenty-four-hour period; and (3) In the case of outpatient benefits, the benefits shall cover services furnished by: (A) A hospital, a psychiatric hospital, or an outpatient psychiatric center licensed by the department; (B) A physician licensed under the Arkansas Medical Practices Act, § 17-95-201 et seq., § 17-95-301 et seq., and § 17-95-401 et seq.; (C) A psychologist licensed under § 17-97-201 et seq.; or (D) A community mental health center or other mental health clinic certified by the division to furnish mental health services as defined in subsection (b) of this section. (b) The insurer or hospital and medical service corporation may establish a copayment requirement for mental illness benefits paid for inpatient, partial hospitalization, or outpatient care described in subsection (a) of this section, which may or may not differ from the copayment requirements for any other condition or illness, except that copayment requirements for mental illness shall not exceed a twenty percent (20%) copayment requirement. (c)(1) For accident and health insurance sold to employers of fifty (50) or fewer employees, the insurer or hospital and medical service corporation shall not impose limits on benefits under subsection (a) of this section with regard to deductible amounts, lifetime maximum payments, payments per outpatient visit, or payments per day of partial hospitalization which differ from benefits for any other condition or illness, provided that the insurer or hospital and medical service corporation may impose an annual maximum benefit payable, which shall not be less than seven thousand five hundred dollars ($7,500) per calendar year. (2) For accident and health insurance sold to employers of fifty-one (51) or more employees, the insurer or hospital and medical service corporation shall not impose limits on benefits under subsection (a) of this section with regard to deductible amounts, lifetime maximum payments, payments per outpatient visit, or payments per day of partial hospitalization which differ from benefits for any other condition or illness, provided that the insurer or hospital and medical service corporation may impose an annual maximum of eight (8) inpatient or partial hospitalization days together with forty (40) outpatient visits. (d) No person shall disclose mental health history, diagnosis, or treatment services information received in an initial application for coverage or subsequent claims for benefits to any person, group, organization, or governmental agency without written consent of the insured, except for purposes of: (1) Obtaining professional review and judgments of quality and appropriateness of treatment rendered; (2) Litigation proceedings involving the insured and when ordered by a court; (3) Reinsurance, when required; (4) Applying over-insurance provisions or for purposes of claiming benefits for services on behalf of the insured; or (5) Underwriting applications for insurance coverage. (e) Nothing in this section shall be construed to prohibit an insurer, a hospital and medical service corporation, a healthcare plan, a health maintenance organization, or other person providing accident and health insurance or medical benefits to Arkansas residents from issuing or continuing to issue an accident and health insurance benefit plan, policy, or contract that provides benefits greater than the minimum benefits required to be made available under this section or from issuing any plans, policies, or contracts that provide benefits that are generally more favorable to the insured than those required to be made available under this section. (f) The requirements of this section with respect to a group or blanket accident and health insurance benefit plan, policy, or subscriber contract shall be satisfied, if the coverage specified is made available to the master policyholder of the plan, policy, or contract. (g)(1)(A) Every insurer or hospital and medical service corporation that issues a group accident and health insurance policy, contract, or agreement in this state that provides for mental health coverage shall offer coverage for the payment of services rendered by licensed professional counselors. (B) The offer shall be made either at the time of application for, or upon the first renewal of, the policy, contract, or agreement after April 1, 1995. (C) If the offer is accepted, the amount paid for services provided by licensed professional counselors shall be subject to the same limitations as set forth in the policy for mental health coverage. (2) Nothing in this subsection shall be deemed to expand the scope of the practice of licensed professional counselors currently licensed by the Arkansas Board of Examiners in Counseling and possessing the qualifications set forth in § 17-27-301 et seq., or other applicable laws.