Amendment defines serious mental illness and permits plan review requirements

The amendment defines “serious mental illness” for health benefit plans. The definition covers health plan beneficiaries with listed disorders, including psychotic, mood, anxiety, trauma-related, eating, personality, and conduct disorders. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders must be used to decide whether a beneficiary has a serious mental illness.

Health insurers may require precertification, prior approval, pre-admission screening, or referrals for covered mental health treatment. The permission applies to mental health disorders that are not serious mental illnesses or substance use disorders, including covered diagnosis and medically necessary treatment services. The listed requirements may include inpatient treatment review and treatment for drug and alcohol dependence. The amendment says this provision does not expand the related prohibition to mental health benefits that are outside that paragraph.