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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: |
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| | | (3) Pervasive developmental disorder, or autism; |
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| | (6) Obsessive-compulsive disorder; or |
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| | (7) Major depressive disorder. |
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| | | 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. |
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| | | (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. |
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| | | (2) At the request of a reimbursing health maintenance | | 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 as for medical | | treatment for physical illness under the group | | contract. |
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| | This subsection does not apply to policies, contracts or | 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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