Medical Necessity in Private Health Plans

Table 7. State Independent Review Statutes With Specific Behavioral Health Provisions

Jurisdiction

Content of Behavioral Health Provision

Pennsylvania

Specifies that licensed psychologists may be reviewers for IROs, with Insurance Department approval. Licensed psychologists may not review denials regarding inpatient care or prescription drugs. 28 Pa. Code § 9.504 (2001).

Vermont

Establishes a separate independent review system for mental health services, including substance abuse treatment. 8 Vt. Stat. § 4089a (2001).
Provides for a seven-member Independent Panel of Mental Health Care Providers appointed by Insurance Commissioner to review mental health service decisions. The Panel must include at least one psychiatrist, psychologist, mental health social worker, psychiatric nurse, mental health counselor, and drug and alcohol counselor.

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