KRS 304.17A-662: Reimbursement for health benefits delivered through psychiatric

collaborative care model -- Exception.

(1) (a) As used in this section, "psychiatric collaborative care model":

1. Means the evidence-based, integrated behavioral health serv ice delivery

method described in 81 Fed. Reg. 80230 (November 15, 2016); and

2. Includes services that are billed under:

a. Except as provided in paragraph (b) of this subsection, the

following Current Procedural Terminology billing codes

maintained by the American Medical Association:

i. 99492;

ii. 99493; and

iii. 99494; and

b. Any other Current Procedural Terminology billing codes

maintained by the American Medical Association that are used for

the evidence -based, integrated behavioral health service delivery

method described in 81 Fed. Reg. 80230 (November 15, 2016).

(b) The commissioner shall promulgate and maintain an administrative regulation

in accordance with KRS Chapter 13A that lists any:

1. Alterations to the billing codes set forth in paragraph (a)2.a. of this

subsection; and

2. Other billing codes that satisfy the requ irements of paragraph (a)2.b. of

this subsection.

(2) Except as provided in subsection (3) of this section, all health benefit plans that

provide coverage for treatment of a mental health condition shall provide

reimbursement for those benefits that are de livered through the psychiatric

collaborative care model.

(3) An insurer may deny reimbursement under a health benefit plan that provides

coverage for treatment of a mental health condition for any benefit billed under a

billing code referenced in subsecti on (1)(a)2. of this section on the grounds of

medical necessity, if the medical necessity determination is:

(a) In compliance with the Paul Wellstone and Pete Domenici Mental Health

Parity and Addiction Equity Act of 2008, codified at 42 U.S.C. sec. 300gg-26,

as amended, and any related federal regulations, as amended; and

(b) Made in accordance with any applicable utilization review requirements set

forth in this subtitle, including but not limited to KRS 304.17A -600 to

304.17A-633.