Ohio § 3923.282

§ 3923.282.

(A) As used in this section: (1) “ Biologically based mental illness ” means schizophrenia, schizoaffective disorder, major depressive disorder, bipolar

disorder, paranoia and other psychotic disorders, obsessive-compulsive disorder, and

panic disorder, as these terms are defined in the most recent edition of the diagnostic

and statistical manual of mental disorders published by the American psychiatric association. (2) “ Plan of health coverage ” includes any private or public employer group self-insurance plan that provides

payment for health care benefits for other than specific diseases or accidents only,

which benefits are not provided by contract with a sickness and accident insurer or

health insuring corporation. (B) Notwithstanding section 3901.71 of the Revised Code , and subject to division (F) of this section, each plan of health coverage shall

provide benefits for the diagnosis and treatment of biologically based mental illnesses

on the same terms and conditions as, and shall provide benefits no less extensive

than, those provided under the plan of health coverage for the treatment and diagnosis

of all other physical diseases and disorders, if both of the following apply: (1) The biologically based mental illness is clinically diagnosed by a physician authorized

under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic

medicine and surgery;  a psychologist licensed under Chapter 4732. of the Revised

Code;  a licensed professional clinical counselor, licensed professional counselor,

independent social worker, or independent marriage and family therapist licensed under

Chapter 4757. of the Revised Code;  or a clinical nurse specialist or certified nurse

practitioner licensed under Chapter 4723. of the Revised Code whose nursing specialty

is mental health. (2) The prescribed treatment is not experimental or investigational, having proven its

clinical effectiveness in accordance with generally accepted medical standards. (C) Division (B) of this section applies to all coverages and terms and conditions of

the plan of health coverage, including, but not limited to, coverage of inpatient

hospital services, outpatient services, and medication;  maximum lifetime benefits;

 copayments;  and individual and family deductibles. (D) This section does not apply to a plan of health coverage if federal law supersedes,

preempts, prohibits, or otherwise precludes its application to such plans.  This section does not apply to long-term care, hospital indemnity, disability income,

or medicare supplement plans of health coverage, or to any other supplemental benefit

plans of health coverage. (E) Nothing in this section shall be construed as prohibiting an employer from taking

any of the following actions in connection with a plan of health coverage: (1) Negotiating separately with mental health care providers with regard to reimbursement

rates and the delivery of health care services; (2) Managing the provision of benefits for the diagnosis or treatment of biologically

based mental illnesses through the use of pre-admission screening, by requiring beneficiaries

to obtain authorization prior to treatment, or through the use of any other mechanism

designed to limit coverage to that treatment determined to be necessary; (3) Enforcing the terms and conditions of a plan of health coverage. (F) An employer that offers a plan of health coverage is not required to provide benefits

for the diagnosis and treatment of biologically based mental illnesses in combination

with benefits for the treatment and diagnosis of all other physical diseases and disorders

as described in division (B) of this section if both of the following apply: (1) The employer submits documentation certified by an independent member of the American

academy of actuaries to the superintendent of insurance showing that incurred claims

for diagnostic and treatment services for biologically based mental illnesses for

a period of at least six months independently caused the employer's costs for claims

and administrative expenses for the coverage of all other physical diseases and disorders

to increase by more than one per cent per year. (2) The superintendent of insurance determines from the documentation and opinion submitted

pursuant to division (F) of this section, that incurred claims for diagnostic and

treatment services for biologically based mental illnesses for a period of at least

six months independently caused the employer's costs for claims and administrative

expenses for the coverage of all other physical diseases and disorders to increase

by more than one per cent per year. Any determination made by the superintendent under this division is subject to Chapter

119. of the Revised Code.