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health conditions may provide coverage for treatment of mental | | health conditions through a managed care organization as long | | as the managed care organization is in compliance with the | | rules adopted by the superintendent that ensure that the | | system for delivery of treatment for mental health conditions | | does not diminish or negate the purpose of this section.__The | | rules adopted by the superintendent shall ensure that timely | | and appropriate access to care is available; that quantity, | | location and specialty distribution of health care providers | | is adequate and that administrative or clinical protocols do | | not serve to reduce access to medically necessary treatment | | for an insured. |
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| | This subsection does not apply to policies, contracts and | certificates covering employees of employers with 20 or fewer | employees, whether the group policy is issued to the employer, to | an association, to a multiple-employer trust or to another | entity. |
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| | | This subsection may not be construed to allow coverage and | | benefits for the treatment of alcoholism or other drug | | dependencies through the diagnosis of a mental illness listed in | | paragraph A. |
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| | | Sec. 4. 24 MRSA §2325-A, sub-§5-D, as amended by PL 1995, c. 637, §2, | | is further amended to read: |
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| | | 5-D. Mandated offer of coverage for certain mental illnesses. | | Except as otherwise provided, coverage for medical treatment for | | mental illnesses listed in paragraph A by all individual and | | group nonprofit hospital and medical services organization health | | care plan contracts is subject to this subsection. |
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| | A. All individual and group contracts must make available | coverage providing provide, at a minimum, benefits according | | to paragraph B, subparagraph (1) for a person receiving | | medical treatment for any of the following mental illnesses | | diagnosed by a licensed allopathic or osteopathic physician | or, a medical doctor, a licensed psychologist who is trained | | and has received a doctorate in psychology specializing in | | the evaluation and treatment of human behavior or a licensed | | master's-level social worker: |
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| | | (3) Pervasive developmental disorder, or autism; |
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