LD 566
pg. 18
Page 17 of 20 An Act to Ensure Equality in Mental Health Coverage Page 19 of 20
Download Bill Text
LR 22
Item 1

 
7. Mandated offer of coverage for certain mental illnesses.
Except as provided in subsection 6, coverage for medical or
psychiatric treatment for mental illnesses listed in paragraph
A by all individual and group contracts is subject to this
subsection.

 
A. All individual and group contracts must make available
coverage providing, at a minimum, benefits according to
paragraph B, subparagraph (1) for a person receiving
medical or psychiatric treatment for any of the following
mental illnesses diagnosed by a licensed allopathic or
osteopathic physician or, a licensed psychologist who is
trained and has received a doctorate in psychology
specializing in the evaluation and treatment of human
behavior mental illness:

 
(1) Schizophrenia;

 
(2) Bipolar disorder;

 
(3) Pervasive developmental disorder, or autism;

 
(4) Paranoia;

 
(5) Panic disorder;

 
(6) Obsessive-compulsive disorder; or

 
(7) Major depressive disorder.

 
B. All individual and group policies, contracts and
certificates executed, delivered, issued for delivery,
continued or renewed in this State on or after July 1,
1996 must make available coverage providing benefits that
meet the requirements of this paragraph. For purposes of
this paragraph, all contracts are deemed renewed no later
than the next yearly anniversary of the contract date.

 
(1) The offer of coverage must provide benefits for
the treatment and diagnosis of mental illnesses under
terms and conditions that are no less extensive than
the benefits provided for medical treatment for
physical illnesses.

 
(2) At the request of a reimbursing health maintenance
organization, a provider of medical or psychiatric treatment
for mental illness shall furnish data substantiating that
initial or continued treatment is medically or psychiatrically
necessary and appropriate. When making the determination of
whether
treatment is medically or psychiatrically necessary and


Page 17 of 20 Top of Page Page 19 of 20