Sec. 7. 24 MRSA §2329, sub-§10, as repealed and replaced by PL 1987, c. 480, §4, is amended to read:

10. Application; expiration. The requirements of this section shall apply to all policies and any certificates or contracts executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 1984. The requirements of subsection 4-A apply to all policies and contracts executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2002. For purposes of this section, all contracts shall be are deemed to be renewed no later than the next yearly anniversary of the contract date.

Sec. 8. 24-A MRSA §2749-D is enacted to read:

§2749-D.__Equitable health care for alcoholism and drug

dependency treatment

1.__Definitions.__As used in this section, unless the context otherwise indicates, the following terms have the following meanings.

A.__"Outpatient care" means care rendered by a state- licensed, approved or certified detoxification, residential treatment or outpatient program or partial hospitalization program on a periodic basis, including, but not limited to, patient diagnosis, assessment and treatment; individual, family and group counseling; and educational and support services.

B.__"Residential treatment" means services at a facility that provides care 24 hours daily to one or more patients, including, but not limited to, room and board; medical, nursing and dietary services; patient diagnosis, assessment and treatment; individual, family and group counseling; and educational and support services, including a designated unit of a licensed health care facility providing any other services specified in this paragraph to patients with the illness of alcoholism or drug dependency.

C.__"Treatment plan" means a written plan initiated at the time of admission, approved by a doctor of medicine, doctor

of osteopathy or a licensed or registered alcohol and drug abuse counselor employed by a certified or licensed substance abuse program, including, but not limited to, the patient's medical, drug and alcoholism history; record of physical examination; diagnosis; assessment of physical capabilities; mental capacity; orders for medication, diet and special needs for the patient's health or safety and treatment, including medical, psychiatric, psychological, social services, individual, family and group counseling; and educational, support and referral services.

2.__Requirement.__An insurer that issues individual health care policies or contracts to residents of this State shall provide benefits as required in this section to a person covered under those policies or contracts for the treatment of alcoholism and other drug dependency pursuant to a treatment plan.

3.__Parity coverage.__An individual health care policy or contract must provide, at a minimum, benefits for the treatment of alcoholism and other drug dependency, including benefits for residential treatment and outpatient care, under terms and conditions that are no less extensive than the benefits provided for medical treatment for physical illness. At the request of an insurer, a provider of treatment for alcoholism or other drug dependency shall furnish data substantiating that the initial or continued treatment is medically necessary and appropriate pursuant to a treatment plan.

4.__Limits; coinsurance; deductibles.__A health care policy or contract that provides coverage for the services required by this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the extent that these provisions are not inconsistent with the requirements of this section.

5.__Notice.__At the time of delivery or renewal, the individual health insurer shall provide written notification to all individuals eligible for benefits under individual health care policies or contracts of the alcoholism and drug dependency benefits provided under this section.

6.__Confidentiality.__The confidentiality of alcoholism and drug treatment patient records must be protected.

7.__Reports to superintendent.__Beginning with the year 2002, an insurer subject to this section shall report its experience for each calendar year to the superintendent not later than April 30th of the following year.__The report must be in a form prescribed by the superintendent and include the amount of claims paid in this State for the services required by this

section and the total amount of claims paid in this State for individual health care policies or contracts, separated according to those paid for inpatient or outpatient services.__The superintendent shall compile this data for all insurers in an annual report.

8.__Application. The requirements of this section apply to policies, certificates or contracts executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2002.__For purposes of this section, a contract is deemed to be renewed no later than the next yearly anniversary of the contract date.

Sec. 9. 24-A MRSA §2842, sub-§3, as enacted by PL 1983, c. 527, §2, is amended to read:

3. Requirement. Every An insurer which that issues group health care contracts providing coverage for hospital care to residents of this State shall provide benefits as required in this section to any subscriber or other a person covered under those contracts for the treatment of alcoholism and other drug dependency pursuant to a treatment plan.

Sec. 10. 24-A MRSA §2842, sub-§4, as enacted by PL 1983, c. 527, §2, is repealed.

Sec. 11. 24-A MRSA §2842, sub-§4-A is enacted to read:

4-A.__Parity coverage.__A group health care contract must provide, at a minimum, benefits for the treatment of alcoholism and other drug dependency, including benefits for residential treatment and outpatient care, under terms and conditions that are no less extensive than the benefits provided for medical treatment for physical illness.__At the request of an insurer, a provider of treatment for alcoholism or other drug dependency shall furnish data substantiating that the initial or continued treatment is medically necessary and appropriate pursuant to a treatment plan.

Sec. 12. 24-A MRSA §2842, sub-§5, as amended by PL 1989, c. 490, §3, is repealed.

Sec. 13. 24-A MRSA §2842, sub-§10, as repealed and replaced by PL 1987, c. 480, §5, is amended to read:

10. Application; expiration. The requirements of this section shall apply to all policies and any certificates or contracts executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 1984. The requirements of subsection 4-A apply to all policies and

contracts executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2002. For purposes of this section, all contracts shall be are deemed to be renewed no later than the next yearly anniversary of the contract date.

Sec. 14. 24-A MRSA §4249 is enacted to read:

§4249.__Equitable health care for alcoholism and drug dependency

treatment

1.__Definitions.__As used in this section, unless the context otherwise indicates, the following terms have the following meanings.

A.__"Outpatient care" means care rendered by a state- licensed, approved or certified detoxification, residential treatment or outpatient program or partial hospitalization program on a periodic basis, including, but not limited to, patient diagnosis, assessment and treatment; individual, family and group counseling; and educational and support services.

B.__"Residential treatment" means services at a facility that provides care 24 hours daily to one or more patients, including, but not limited to, room and board; medical, nursing and dietary services; patient diagnosis, assessment and treatment; individual, family and group counseling; and educational and support services, including a designated unit of a licensed health care facility providing any other services specified in this paragraph to patients with the illness of alcoholism or drug dependency.

C.__"Treatment plan" means a written plan initiated at the time of admission, approved by a doctor of medicine, doctor of osteopathy or a licensed or registered alcohol and drug abuse counselor employed by a certified or licensed substance abuse program, including, but not limited to, the patient's medical, drug and alcoholism history; record of physical examination; diagnosis; assessment of physical capabilities; mental capacity; orders for medication, diet and special needs for the patient's health or safety and treatment, including medical, psychiatric, psychological, social services, individual, family and group counseling; and educational, support and referral services.

2.__Requirement.__A health maintenance organization that issues individual and group health care policies or contracts to residents of this State shall provide benefits as required in this section to a person covered under those policies or contracts for the treatment of alcoholism and other drug dependency pursuant to a treatment plan.

3.__Parity coverage.__An individual and group health care policy or contract must provide, at a minimum, benefits for the treatment of alcoholism and other drug dependency, including benefits for residential treatment and outpatient care, under terms and conditions that are no less extensive than the benefits provided for medical treatment for physical illness. At the request of a health maintenance organization, a provider of treatment for alcoholism or other drug dependency shall furnish data substantiating that the initial or continued treatment is medically necessary and appropriate pursuant to a treatment plan.

4.__Limits; coinsurance; deductibles.__A health care policy or contract that provides coverage for the services required by this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the extent that these provisions are not inconsistent with the requirements of this section.

5.__Notice.__At the time of delivery or renewal, the health maintenance organization shall provide written notification to all individuals eligible for benefits under individual and group health care policies or contracts of the alcoholism and drug dependency benefits provided under this section.

6.__Confidentiality.__The confidentiality of alcoholism and drug treatment patient records must be protected.

7.__Reports to superintendent.__Beginning with the year 2002, a health maintenance organization subject to this section shall report its experience for each calendar year to the superintendent not later than April 30th of the following year.__ The report must be in a form prescribed by the superintendent and include the amount of claims paid in this State for the services required by this section and the total amount of claims paid in this State for individual and group health care policies or contracts, separated according to those paid for inpatient or outpatient services.__The superintendent shall compile this data for all insurers in an annual report.

8.__Application. The requirements of this section apply to policies, certificates or contracts executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2002.__For purposes of this section, a contract is deemed to be renewed no later than the next yearly anniversary of the contract date.

SUMMARY

This bill requires that all individual and group health insurance policies or contracts provide coverage for substance abuse treatment under the same terms and conditions as coverage for physical conditions and illnesses. The bill applies to all policies and contracts issued or renewed on or after January 1, 2002.