LD 566
pg. 4
Page 3 of 20 An Act to Ensure Equality in Mental Health Coverage Page 5 of 20
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LR 22
Item 1

 
(1) The contracts 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 nonprofit hospital or and
medical service 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 appropriate, the provider shall use the
same criteria for medical or psychiatric treatment
for mental illness as for medical treatment for
physical illness under the group contract.

 
(3)__If benefits and coverage for treatment of
physical illness are provided on an expense-incurred
basis, the benefits and coverage required under this
subsection may be delivered separately under a
managed care system.

 
(4)__A policy or contract may not have separate
maximums for physical illness and mental illness,
separate deductibles and coinsurance amounts for
physical illness and mental illness, separate out-of-
pocket limits in a benefit period of not more than 12
months for physical illness and mental illness or
separate office visitation limits for physical
illness and mental illness.

 
(5)__A health benefit plan may not impose a
limitation on coverage or benefits for mental illness
unless that same limitation is also imposed on the
coverage and benefits for physical illness covered
under the policy or contract.

 
(6)__Copayments required under a policy or contract
for benefits and coverage for mental illness must be
actuarially equivalent to any coinsurance
requirements or, if there are no coinsurance
requirements, not greater than any copayment required
under the policy or contract for a benefit or
coverage for a physical illness.

 
(7)__For the purposes of this section, medication management
visits associated with a mental illness must be covered in the
same manner as a medication management visit for the treatment
of a physical


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