LD 1778
pg. 4
Page 3 of 9 An Act to Make Corrections in the Mental Health Insurance Laws Page 5 of 9
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LR 2291
Item 1

 
5-C. Coverage for treatment for certain mental illnesses.
Coverage for medical treatment for mental illnesses listed in
paragraph A is subject to this subsection.

 
A. All group contracts must 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 licensed psychologist who is trained and has
received a doctorate in psychology specializing in the
evaluation and treatment of human behavior:

 
(1) Schizophrenia;

 
(2) Bipolar disorder;

 
(3) Pervasive developmental disorder, or autism;

 
(4) Paranoia;

 
(5) Panic disorder;

 
(6) Obsessive-compulsive disorder; or

 
(7) Major depressive disorder.;

 
(8)__Anorexia; or

 
(9)__Bulimia.

 
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.

 
(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


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