LD 1000
pg. 3
Page 2 of 7 An Act to Provide Insurance Parity for Substance Abuse Treatment Page 4 of 7
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LR 1458
Item 1

 
of Osteopathy or a licensed or registered alcohol and drug
abuse counselor employed by a certified or licensed substance
abuse program, including, but not limited to, the patient's
medical, drug and alcoholism history; record of physical
examination; diagnosis; assessment of physical capabilities;
mental capacity; orders for medication, diet and special needs
for the patient's health or safety and treatment, including
medical, psychiatric, psychological, social services,
individual, family and group counseling; and educational,
support and referral services.

 
2.__Requirement.__An insurer that issues individual health
care contracts to residents of this State shall provide benefits
as required in this section to a person covered under those
contracts for the treatment of alcoholism and other drug
dependency pursuant to a treatment plan.

 
3.__Parity coverage.__An individual contract must provide, at
a minimum, benefits for the treatment of alcoholism and other
drug dependency, including benefits for residential treatment and
outpatient care, under terms and conditions that are no less
extensive than the benefits provided for medical treatment for
physical illness. At the request of an insurer, a provider of
treatment for alcoholism or other drug dependency shall furnish
data substantiating that the initial or continued treatment is
medically necessary and appropriate pursuant to a treatment plan.

 
4.__Limits; coinsurance; deductibles.__A policy or contract
that provides coverage for the services required by this section
may contain provisions for maximum benefits and coinsurance and
reasonable limitations, deductibles and exclusions to the extent
that these provisions are not inconsistent with the requirements
of this section.

 
5.__Notice.__At the time of delivery or renewal, the
individual health insurer shall provide written notification to
all individuals eligible for benefits under individual policies
or contracts of the alcoholism and drug dependency benefits
provided under this section.

 
6.__Confidentiality.__The confidentiality of alcoholism and
drug treatment patient records must be protected.

 
7.__Reports to the superintendent.__Beginning with the year
2000, an insurer subject to this section shall report its
experience for each calendar year to the superintendent not later
than April 30th of the following year.__The report must be in a
form prescribed by the superintendent and include the amount of
claims paid in this State for the services required by this
section and the total amount of claims paid in this State for


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