LD 1158, Page 5 - 119th Legislature, FIRST REGULAR Session

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

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 commissioner that ensure that

the system of 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 the 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 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. 5. 24 MRSA з2325-A, sub-зз7-A and 7-B are enacted to read:

7-A.__Compliance.__A health insurance plan is construed to be
in compliance with this section if at least one choice for
treatment of mental health conditions provided to the insured
within the plan has rates, terms and conditions that place no
greater financial burden on the insured than for access to
treatment of physical conditions.__The superintendent may
disapprove any plan that the superintendent determines to be
inconsistent with the purposes of this section.

7-B.__Coverage eligibility.__To be eligible for coverage under
this section, the service must be for treatment of mental illness
and rendered by a licensed or certified mental health
professional or in a mental health facility qualified pursuant to
rules adopted by the superintendent, or in an institution
approved by the superintendent that provides a program for the
treatment of a mental health condition pursuant to a written
plan.__A nonprofit hospital or a medical service corporation may
require a mental health facility or licensed or certified mental
health professional to enter into a contract as a condition of
providing benefits.

Sec. 6. 24 MRSA з2325-A, sub-з8, as amended by PL 1995, c. 407, з3, is
further amended to read:

8. Reports to the Superintendent of Insurance. Every
nonprofit hospital or medical service organization subject to

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