§ 62Q.53 — Mental Health Coverage; Medically Necessary Care
Plain-Language Summary
Addresses mental health coverage; medically necessary care coverage requirements for health plans.
62Q.53 MENTAL HEALTH COVERAGE; MEDICALLY NECESSARY CARE.
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Subdivision 1.Requirement.
No health plan that covers mental health services may be offered, sold, issued, or renewed in this state that requires mental health services to satisfy a definition of “medically necessary care,” “medical necessity,” or similar term that is more restrictive with respect to mental health than the definition provided in subdivision 2. §
Subd. 2.Minimum definition.
“Medically necessary care” means health care services appropriate, in terms of type, frequency, level, setting, and duration, to the enrollee’s diagnosis or condition, and diagnostic testing and preventive services. Medically necessary care must be consistent with generally accepted practice parameters as determined by health care providers in the same or similar general specialty as typically manages the condition, procedure, or treatment at issue and must:
(1) help restore or maintain the enrollee’s health; or
(2) prevent deterioration of the enrollee’s condition. §
Subd. 3.Health plan; definition.
For purposes of this section, “health plan” has the meaning given in section 62Q.01, subdivision 3, but includes the coverages listed in section 62A.011, subdivision 3, clauses (7) and (10).
History:
History: History:
1997 c 49 s 1