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Current through October 23, 2012
(a) Except as described in subsection (b) of this section, each health insurer that offers individual or group health plans or certificates issued or delivered in the District to an employer or individual shall provide coverage for the medical and psychological treatment of drug abuse, alcohol abuse, and mental illness.
(b) The requirements of this chapter shall not apply to dread disease policies, student policies, nursing home policies, and home health care policies.
(c) Covered benefits for drug abuse, alcohol abuse, and mental illness in insurance policies and contracts subject to this chapter shall be limited to inpatient, residential, and outpatient services certified as necessary by a physician, psychologist, advanced practice registered nurse, or social worker.
(d) Before an insured party may qualify to receive benefits under this chapter, a physician, psychologist, advanced practice registered nurse, or social worker shall certify that the individual has a drug addiction or an alcohol addiction or a mental illness and prescribe appropriate treatment, which may include referral to other treatment providers.
(e) All drug abuse, alcohol abuse, and mental illness treatment or services eligible for health insurance coverage shall be subject to peer review procedures. These procedures may be initiated by a health insurer in the course of reviewing claims for payment.
(f) Repealed.
(g) All individual health benefit plans or certificates shall offer coverage for the medical and psychological treatment of drug abuse, alcohol abuse, and mental illness. Coverage shall be offered for at least the minimum levels set forth in §§ 31-3103 and 31-3104.
(h) Group health benefit plans or certificates that are the result of collective bargaining between a legally-certified union and the employer shall be required to include coverage for inpatient and outpatient treatment of drug abuse, alcohol abuse, and mental illness. The minimum levels of coverage set forth in §§ 31-3103 and 31-3104 shall not apply to those group health benefit plans or certificates until 5 years from February 28, 1987, unless the Mayor requests the Council to extend the exemption to a time certain and the Council, by resolution, approves the extension.
(i) If a large group health benefit plan offers a participant or beneficiary 2 or more benefit package options under the plan, the requirements of this chapter shall be applied separately to each option.
(j) A health insurer may require that substance abuse and mental illness insurance coverage shall be provided through a managed care system.
(Feb. 28, 1987, D.C. Law 6-195, § 3, 34 DCR 491; Apr. 30, 1988, D.C. Law 7-104, § 21, 35 DCR 147; Mar. 16, 1993, D.C. Law 9-192, § 2(a), (b), 39 DCR 9007; Mar. 23, 1995, D.C. Law 10-247, § 3, 42 DCR 457; Oct. 21, 2000, D.C. Law 13-178, § 2(b), 47 DCR 6844; Mar. 8, 2007, D.C. Law 16-242, § 2(b), 54 DCR 601; Apr. 24, 2007, D.C. Law 16-305, § 42, 53 DCR 6198.)
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 35-2302.
Effect of Amendments
D.C. Law 13-178 added subsec. (i).
D.C. Law 16-242 rewrote subsecs. (a) and (b); in subsec. (e), substituted "a health insurer" for "an insurer"; repealed subsec. (f); in subsec. (g), substituted "health benefit plans or certificates" for "subscriber contracts or policies"; in subsec. (h), substituted "health benefit plans or certificates" for "health insurance policies or contracts"; in subsec. (i), substituted "health benefit plan" for "health plan"; and added subsec. (j). Prior to amendment, subsecs. (a), (b), and (f) read as follows:
"(a) All group health insurance policies providing coverage on an expenses-incurred basis, and group service or indemnity-type contracts issued by a nonprofit health service plan shall provide coverage for the medical and psychological treatment of drug abuse, alcohol abuse, and mental illness.
"(b)(1) The requirements of this chapter shall apply to:
"(A) All individual subscriber contracts and group certificates issued or delivered in the District by Group Hospitalization and Medical Services, Incorporated;
"(B) All for-profit as well as not-for-profit indemnity type health insurers issuing or delivering individual indemnity type accident and sickness health insurance policies and group certificates in the District; and
"(C) Health insurance certificates, except those described in paragraph (2) of this subsection, that are delivered within the District from group health insurance policies which are sold outside the District.
"(2) The requirements of this chapter shall not apply to Medicare supplement policies, accident-only policies, dread disease policies, student accident policies, nursing home policies, and home health care policies."
"(f) This chapter shall apply only to group health insurance policies or contracts issued in the District to cover individuals who are residents of, or employed in, the District."
D.C. Law 16-305, in subsec. (d), substituted "has a drug addiction or an alcohol addiction or a mental illness" for "is suffering from drug abuse, alcohol abuse, or mental illness".
Temporary Amendments of Section
For temporary (225 day) amendment of section, see § 2(b) of Drug Abuse, Alcohol Abuse, and Mental Illness Insurance Coverage Temporary Amendment Act of 1998 (D.C. Law 12-108, May 8, 1998, law notification 45 DCR 3259).
Emergency Act Amendments
For temporary amendment of section, see § 2(b) of the Drug Abuse, Alcohol Abuse, and Mental Illness Insurance Coverage Emergency Amendment Act of 1998 (D.C. Act 12-274, February 19, 1998, 45 DCR 1526), and § 2(b) of the Drug Abuse, Alcohol Abuse, and Mental Illness Insurance Coverage Second Emergency Amendment Act of 1998 (D.C. Act 12-546, December 18, 1998, 46 DCR 497).
Legislative History of Laws
For legislative history of D.C. Law 6-195, see Historical and Statutory Notes following § 31-3101.
Law 7-104, the "Technical Amendments Act of 1987," was introduced in Council and assigned Bill No. 7-346, which was referred to the Committee of the Whole. The Bill was adopted on first and second readings on Nov. 24, 1987 and Dec. 8, 1987, respectively. Signed by the Mayor on Dec. 22, 1987, it was assigned Act No. 7-124 and transmitted to both Houses of Congress for its review.
Law 9-192, the "Drug Abuse, Alcohol Abuse, and Mental Illness Insurance Coverage Amendment Act of 1992," was introduced in Council and assigned Bill No. 9-310, which was referred to the Committee on Consumer and Regulatory Affairs. The Bill was adopted on first and second readings on October 6, 1992, and November 4, 1992, respectively. Signed by the Mayor on November 23, 1992, it was assigned Act No. 9-313 and transmitted to both Houses of Congress for its review. D.C. Law 9-192 became effective on March 16, 1993.
For legislative history of D.C. Law 10-247, see Historical and Statutory Notes following § 31-3101.
For Law 13-178, see notes following § 31-3101.
For Law 16-242, see notes following § 31-3101.
For Law 16-305, see notes following § 31-1131.11.
