| (a) Criteria for medical necessity determinations.
The criteria for medical necessity determinations made under a health
benefit plan with respect to mental health or substance use disorder
benefits must be made available by the issuer to any enrollee or contracting
provider upon request, consistent with Insurance Code Chapters 843
and 1301.
(b) Reason for denial. The reason for any denial under
a health benefit plan with respect to mental health or substance use
disorder benefits in the case of any enrollee must be made available
by the issuer in a form and manner consistent with Insurance Code §4201.303,
concerning Adverse Determination: Contents of Notice.
(c) Provisions of other law. Compliance with the disclosure
requirements in subsections (a) and (b) of this section is not determinative
of compliance with any other provision of applicable federal or state
law.
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