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§ 6060.11b. Reimbursement for benefits delivered through behavioral health integration and psyc...

Oklahoma Statutes AnnotatedTitle 36. InsuranceEffective: November 1, 2023

Oklahoma Statutes Annotated
Title 36. Insurance (Refs & Annos)
Chapter 2. Miscellaneous Provisions
Mental Health and Substance Abuse
Effective: November 1, 2023
36 Okl.St.Ann. § 6060.11b
§ 6060.11b. Reimbursement for benefits delivered through behavioral health integration and psychiatric collaborative care models
A. For the purposes of this section:
1. “Behavioral health integration” means an approach to delivering mental health care that improves the ability for primary care providers to include mental and behavioral health screening, treatment, and specialty care into their practice pursuant to Current Procedural Terminology billing code 99484, as established by the American Medical Association;
2. “Health benefit plan” means a plan as defined pursuant to Section 6060.4 of Title 36 of the Oklahoma Statutes;
3. “Mental health and substance abuse disorder benefits” means benefits for the treatment of any condition or disorder that involves a mental health condition or substance abuse disorder, including, but not limited to, those that fall under any of the diagnostic categories listed in the mental disorders section of the most recent edition of the International Classification of Diseases or in the mental disorders section of the most recent version of the Diagnostic and Statistical Manual of Mental Disorders;
4. “Oklahoma Medicaid Program” means the state program administered by the Oklahoma Health Care Authority pursuant to Section 1002 of Title 56 of the Oklahoma Statutes; and
5. “Psychiatric collaborative care model” means the evidence-based, integrated behavioral health service delivery method described pursuant to 81 C.F.R. 80230. The model shall include, but not be limited to, the following Current Procedural Terminology billing codes, as established by the American Medical Association:
a. 99492,
b. 99493, and
c. 99494.
B. 1. Any health benefit plan that is offered, issued, or renewed in this state and that provides mental health or substance abuse disorder benefits shall provide reimbursement for such benefits that are delivered through the behavioral health integration and psychiatric collaborative care models.
2. The Oklahoma Medicaid Program shall provide reimbursement for such benefits that are delivered through the behavioral health integration and psychiatric collaborative care models.
3. Plans offered, issued, or renewed in this state that provide benefits under this subsection may deny reimbursement of any Current Procedural Terminology code pursuant to paragraph 3 of subsection A of this section due to medical necessity; provided, such medical necessity determinations shall be in compliance with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, as amended,1 and its implementing and related regulations, and in accordance with the utilization review requirements pursuant to Section 6551 et seq. of Title 36 of the Oklahoma Statutes and the review and denial of mental health and substance abuse disorder treatments and services in Section 1250.5 et seq. of Title 36 of the Oklahoma Statutes.

Credits

Laws 2023, c. 374, § 1, eff. Nov. 1, 2023.

Footnotes

Pub.L.No. 110-343, 122 Stat. 3881.
36 Okl. St. Ann. § 6060.11b, OK ST T. 36 § 6060.11b
Current with emergency effective legislation through Chapter 257 of the Second Regular Session of the 59th Legislature (2024). Some sections may be more current, see credits for details.
End of Document