LD 563
pg. 4
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LR 764
Item 1

 
services provided by physicians or psychologists, this section
applies to all health insurance policies, contracts or certificates
issued, renewed, modified, altered, amended or reissued on or after
April 16, 1976. Payment or reimbursement for services rendered by
clinical social workers licensed in this State shall, licensed
clinical professional counselors licensed in this State or licensed
nurses certified by the American Nurses' Association as clinical
specialists in adult or child and adolescent psychiatric and mental
health nursing may not be conditioned upon prior diagnosis or
referral by a physician or other health care professional, except
in cases where diagnosis of the condition for which the services
are rendered is beyond the scope of their licensure.

 
2. Nothing in subsection 1 may be construed to require a
health insurance policy subject to this chapter to provide for
reimbursement of services which that are within the lawful scope
of practice of a psychologist licensed to practice in this State,
a clinical social worker licensed in this State, a clinical
professional counselor licensed in this State, a certified social
worker licensed to practice in this State, or a nurse certified
and licensed to practice in this State.

 
3. Mental health services provided by counseling
professionals. An Except as provided in subsection 1 with regard
to reimbursement of clinical professional counselors licensed in
this State, an insurer that issues group health care contracts
providing coverage for mental health services shall make
available coverage for those services when performed by a
counseling professional who is licensed by the State pursuant to
Title 32, chapter 119 to assess and treat interpersonal and
intrapersonal problems, has at least a masters degree in
counseling or a related field from an accredited educational
institution and has been employed as a counselor for at least 2
years. Any contract providing coverage for the services of
counseling professionals pursuant to this section may be subject
to any reasonable limitations, maximum benefits, coinsurance,
deductibles or exclusion provisions applicable to overall
benefits under the contract. This subsection applies to all
contracts executed, delivered, issued for delivery, continued or
renewed in this State on or after January 1, 1997. For purposes
of this subsection, all contracts are deemed renewed no later
than the next yearly anniversary of the contract date.

 
Sec. 3. 24-A MRSA §4234-A, sub-§8, as amended by PL 2003, c. 20, Pt.
VV, §22 and affected by §25, is further amended to read:

 
8. Contracts; providers. A health maintenance organization
incorporated under this chapter shall allow


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