Section 12-17.6-4-2 - Services covered; prohibition on treatment limitations or financial requirements; mental health services(a) The benefit package provided under the program shall focus on age appropriate preventive, primary, and acute care services.(b) The office shall offer health insurance coverage for the following basic services:(1) Inpatient and outpatient hospital services.(2) Physicians' services provided by a physician (as defined in 42 U.S.C. 1395x(r)).(3) Laboratory and x-ray services.(4) Well-baby and well-child care, including: (A) age appropriate immunizations; and(B) periodic screening, diagnosis, and treatment services according to a schedule developed by the office. The office may offer services in addition to those listed in this subsection if appropriations to the program exist to pay for the additional services.
(c) The office shall offer health insurance coverage for the following additional services if the coverage for the services has an actuarial value equal to or greater than the actuarial value of the services provided by the benchmark program determined by the children's health policy board established by IC 4-23-27-2: (2) Mental health services.(d) Notwithstanding subsections (b) and (c), the office may not impose treatment limitations or financial requirements on the coverage of services for a mental illness if similar treatment limitations or financial requirements are not imposed on coverage for services for other illnesses. Coverage for mental illness under the program must include the following: (1) Inpatient mental health services and substance abuse services provided in an institution that: (A) treats mental disease; and(B) has more than sixteen (16) beds; unless coverage is prohibited by federal law.
(2) Psychiatric residential treatment services.(3) Community mental health rehabilitation services.(4) Outpatient mental health services and substance abuse services, with no greater limitations on the number of units per rolling year than are required under the Medicaid program. However, the office may require prior authorization for the services specified in subdivisions (1) through (4).
As added by P.L. 273-1999, SEC.177. Amended by P.L. 103-2009, SEC.1.