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ENGROSSED HOUSE AMENDME NT
TO
ENGROSSED SENATE BILL NO . 444 By: Montgomery of the Senate
and
Miller of the House
[ mental health and substance use disorder benefits -
reimbursement - necessity determination -
codification - effective date ]
AUTHOR: Add the following House Coauthor: Provenzano
AMENDMENT NO. 1. Strike the title, enacting clause, and entire bill
and insert:
"An Act relating to ment al health and substance abuse
disorder benefits; defining terms; requiring certain
health benefit plans and Oklahoma Medicaid Program to
provide reimbursement for c ertain care pursuant to
certain models; allowing for denial of reimburs ement
under certain circumstances; providing for necessity
determination; providing for codification; and
providing an effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new sectio n of law to be codified
in the Oklahoma Statutes as Section 6060.11a of Title 36, unless
there is created a duplication in numbering, reads as follows:
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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 i nto 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 pur suant 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 C lassification 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 he alth service delivery method
described pursuant to 81 C.F.R. 80230. The model shall include, b ut
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not be limited to, the following Current Procedural Terminology
billing codes, as established by the Amer ican 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 th at 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 pro vide 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, 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 d enial of mental health and
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substance abuse disorder treatments an d services in Section 1250.5
et seq. of Title 36 of the Oklahoma Statutes.
SECTION 2. This act shall become effective November 1, 2023."
Passed the House of Representatives the 26th day of April, 2023.
Presiding Officer of the House of
Representatives
Passed the Senate the ____ day of __________, 2023.
Presiding Officer of the Senate
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ENGROSSED SENATE
BILL NO. 444 By: Montgomery of the Senate
and
Miller of the House
[ mental health and substance use disorder benefits -
reimbursement - necessity determination -
codification - effective date ]
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 3. NEW LAW A new section of law to be codified
in the Oklahoma Statu tes as Section 6060.11a of Title 36, unless
there is created a duplication in numbering, reads as follows:
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 i nto 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 pur suant 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 disord er that
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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 Classificatio n 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 he alth 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 Amer ican 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 tha t 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.
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2. The Oklahoma Medicaid Program shall provide re imbursement
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, 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 deni al of substance use
disorder treatments an d services in Section 1250.5 et seq. of Title
36 of the Oklahoma Statutes.
SECTION 4. This act shall become effective November 1, 2023.
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Passed the Senate the 8th day of March, 2023.
Presiding Officer of the Senate
Passed the House of Representatives the ____ day of __________,
2023.
Presiding Officer of the House
of Representatives