Section 10-16-166 - Prohibition on using the body mass index or ideal body weight - medical necessity criteria - rules

(1)(a) Every health benefit plan subject to part 2, 3, or 4 of this article 16, except those described in section 10-16-102 (32)(b), shall not utilize the body mass index, ideal body weight, or any other standard requiring an achieved weight when determining medical necessity or the appropriate level of care for an individual diagnosed with an eating disorder, including but not limited to bulimia nervosa, atypical anorexia nervosa, binge-eating disorder, avoidant restrictive food intake disorder, and other specified feeding and eating disorders as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.(b) Subsection (1)(a) of this section does not apply when determining medical necessity or the appropriate level of care for an individual diagnosed with anorexia nervosa, restricting subtype, or binge-eating/purging subtype; however, body mass index, ideal body weight, or any other standard requiring an achieved body weight must not be the determining factor when assessing medical necessity or the appropriate level of care for an individual diagnosed with anorexia nervosa, restricting subtype, or binge-eating/purging subtype.(2) The following

ning factor when assessing medical necessity or the appropriate level of care for an individual diagnosed with anorexia nervosa, restricting subtype, or binge-eating/purging subtype.(2) The following factors, at a minimum, must be considered when determining medical necessity or the appropriate level of care for an individual diagnosed with an eating disorder: (a) The individual's eating behaviors;(b) The individual's need for supervised meals and support interventions;(c) Laboratory results, including, but not limited to, the individual's heart rate, renal or cardiovascular activity, and blood pressure;(d) The recovery environment; and(e) Co-occurring disorders the individual may have.(3) The commissioner may promulgate rules as necessary to implement and enforce this section.Added by 2023 Ch. 275,§ 1, eff. 1/1/2024.