SB 6405 - DIGEST

     Provides that every health carrier that provides coverage for any outpatient mental health service shall comply with the following requirements:  (1) In performing a utilization review of services for a specific enrollee, the person performing the utilization review is limited to accessing only the specific health care information for the particular enrollee in question that is necessary to complete the review.  Necessary information for the enrollee means only the symptoms, diagnoses, and treatment plan relevant to the mental health diagnosis; and

     (2) in performing an audit of services, the person performing the audit is limited to accessing only the records of persons covered by the specific health carrier for which the audit is being performed.  Accessible records include information related only to the symptoms, diagnoses, and treatment plans relevant to the mental health diagnosis.