Ohio § 3923.29

§ 3923.29.

(A)(1) Every policy of group sickness and accident insurance providing hospital, surgical,

or medical expense coverage for other than specific diseases or accidents only, and

delivered, issued for delivery, or renewed in this state on or after January 1, 1979,

shall provide for each eligible person under the policy who resides in this state,

outpatient, inpatient, and intermediate primary care benefits for alcoholism that

are at least equal to five hundred fifty dollars in any calendar year or twelve-month

period. (2) The services shall be legally performed by or under the clinical supervision of any

of the following: (a) A physician authorized under Chapter 4731. of the Revised Code to practice medicine

and surgery or osteopathic medicine and surgery; (b) A psychologist licensed under Chapter 4732. of the Revised Code; (c) 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 whose practice includes chemical dependency counseling; (d) An independent chemical dependency counselor licensed under Chapter 4758. of the

Revised Code; (e) A clinical nurse specialist or certified nurse practitioner licensed under Chapter

4723. of the Revised Code whose nursing specialty is mental health. (3) The services may be performed in an office, in a hospital, in a community mental

health facility, or in an alcoholism treatment facility so long as the hospital, community

mental health facility, or alcoholism treatment facility is approved by the joint

commission, the council on accreditation, or the commission on accreditation of rehabilitation

facilities or certified by the department of mental health and addiction services. (B) The benefits mandated by division (A) of this section shall be subject to reasonable

contract limitations and may be subject to reasonable deductibles and co-insurance

costs.  Persons entitled to such benefit under more than one service or insurance contract

may be limited to a single five hundred fifty dollar benefit for services under all

contracts. (C) For an eligible person, who receives treatment for alcoholism from an approved or

certified alcoholism treatment facility, to remain entitled to the benefits mandated

by division (A) of this section, a health care professional identified in division

(A)(2) of this section shall every three months certify that such person needs to

continue utilizing such treatment. (D) In order to qualify for participation under division (A) of this section, every facility

specified in such division shall have in effect a plan for utilization review and

a plan for peer review and every person specified in such division shall have in effect

a plan for peer review.  Such plans shall have the purpose of ensuring high quality patient care and effective

and efficient utilization of available health facilities and services.  Such person or facility shall also have in effect a program of rehabilitation or

a program of rehabilitation and detoxification. (E) Nothing in this section shall be construed to require an insurer to pay benefits

which are greater than usual, customary, and reasonable.