LD 1158
pg. 2
Page 1 of 7 An Act to Ensure Equality in Mental Health Coverage for Children and Adults ... Page 3 of 7
Download Bill Text
LR 14
Item 1

 
(7) Major depressive disorder.; or

 
(8)__Eating disorders:

 
(a)__Bulimia; and

 
(b)__Anorexia.

 
Any person birth to 18 years of age with a mental health
condition that falls under any of the diagnostic categories
listed in the mental disorders section of the Diagnostic and
Statistical Manual of Mental Health Disorders, 4th Edition,
DMS 4, as periodically revised, is covered under this
paragraph.

 
B. All policies, contracts and certificates executed,
delivered, issued for delivery, continued or renewed in this
State on or after July 1, 1996 must provide 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 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. A health insurance plan must provide
coverage for treatment of a mental health condition and
may not establish a rate, term or condition that places
a greater financial burden on an insured for access to
treatment for a mental health condition than for access
to treatment for a physical health condition.__Any
deductible or out-of-pocket limits required under a
health insurance plan must be comprehensive for
coverage of both mental health and physical health
conditions.

 
(2) At the request of a nonprofit hospital or medical
service organization, a provider of medical treatment
for mental illness shall furnish data substantiating
that initial or continued treatment is medically
necessary and appropriate. When making the
determination of whether treatment is medically
necessary and appropriate, the provider shall use the
same criteria for medical treatment for mental illness
as for medical treatment for physical illness under the
group contract.

 
C.__A health insurance plan that does not otherwise provide for
management of care under the plan or that does not provide for
the same degree of management of care for all


Page 1 of 7 Top of Page Page 3 of 7