|
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. |
|
| 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. |
|
| 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. |
|
| | Sec. 4. 24 MRSA §2325-A, sub-§5-D, as amended by PL 1995, c. 637, §2, | is further amended to read: |
|
| | 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. |
|
| 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: |
|
| (3) Pervasive developmental disorder, or autism; |
|
|