LD 1158
pg. 3
Page 2 of 7 An Act to Ensure Equality in Mental Health Coverage for Children and Adults ... Page 4 of 7
Download Bill Text
LR 14
Item 1

 
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:

 
(1) Schizophrenia;

 
(2) Bipolar disorder;

 
(3) Pervasive developmental disorder, or autism;

 
(4) Paranoia;


Page 2 of 7 Top of Page Page 4 of 7