C.__"Day treatment services" includes psychoeducational, physiological, psychological and psychosocial concepts, techniques and processes necessary to maintain or develop functional skills of clients, provided to individuals or groups for periods of more than 2 hours but less than 24 hours per day.

D.__"Health benefit plan" means:

(1)__Policies, contracts or certificates for hospital or medical benefits that are offered, renewed, amended, executed, continued, delivered or issued for delivery in this State to an employer or individual on an individual or group basis or on an individual or group subscription basis, and that provide coverage for residents of this State;

(2)__Nonprofit hospital or medical service organization indemnity plans;

(3)__Health maintenance organization subscriber or group master contracts;

(4)__Preferred provider plans;

(5)__Health benefit plans offered or administered by the State or by any subdivision or instrumentality of the State;

(6)__Multiple-employer welfare arrangements or associations located in this State or another state and that cover residents of this State who are eligible employees; or

(7)__Employer self-insured plans that are not exempt pursuant to the__federal Employee Retirement Income Security Act of 1974 provisions.

"Health benefit plan" does not include accident-only insurance, fixed indemnity insurance, credit health insurance, Medicare supplement policies, Civilian Health and Medical Program of the Uniformed Services supplement policies, long-term care insurance, disability income insurance, workers' compensation or similar insurance, disease-specific insurance, automobile medical payment insurance, dental insurance or vision insurance.

E.__"Home support services" means rehabilitative services,

treatment services and living skills services provided for a person with a mental illness.__"Home support services" may be provided in a community setting or the person's current place of residence, and are services that promote the integration of the person into the community, sustain the person in the person's current living situation or another living situation of that person's choosing and enhance the quality of the person's life. "Home support services" may be provided directly to the person or indirectly through collateral contact or by telephone contact or other means on behalf of the person.__"Home support services" includes, but is not limited to:

(1)__Case management services and assertive community treatment services;

(2)__Medication education and monitoring;

(3)__Crisis intervention and resolution services and follow-up services; and

(4)__Individual, group and family counseling services.

F.__"Inpatient services" includes, but is not limited to, a range of physiological, psychological and other intervention concepts, techniques and processes in a community mental__ health psychiatric inpatient unit, general hospital psychiatric unit or psychiatric hospital licensed by the Department of Human Services or accredited public hospital to restore psychosocial functioning sufficient to allow maintenance and support of a person suffering from a mental illness in a less restrictive setting.

G.__"Inpatient treatment" means mental health or substance abuse services delivered on a 24-hour per day basis in a hospital, accredited public hospital, alcohol or drug rehabilitation facility, intermediate care facility, community mental health psychiatric inpatient unit, general hospital psychiatric unit or psychiatric hospital licensed by the Department of Human Services.

H.__"Intermediate care facility" means a licensed, residential public or private facility that is not a hospital and that is operated primarily for the purpose of providing a continuous, structured 24-hour per day, state- approved program of inpatient substance abuse services.

I.__"Mental health services" means treatment for mental illnesses.

J.__"Mental illness" is any mental or nervous condition that affects a person by impairing the person's psychobiological processes severely enough that the person manifests problems in the areas of social, psychological or biological functioning.__A person with mental illness has a disorder of thought, mood, perception, orientation or memory that impairs judgment, behavior, capacity to recognize or ability to cope with the ordinary demands of life.__A person with mental illness manifests an impaired capacity to maintain acceptable levels of functioning in the areas of intellect, emotion or physical well-being.__"Mental illness" includes, but is not limited to, any of the following illnesses for which the diagnostic criteria are prescribed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, as periodically revised, as the illness applies to adults and children:

(1)__Psychotic disorders, including schizophrenia;

(2)__Dissociative disorders;

(3)__Mood disorders;

(4)__Anxiety disorders;

(5)__Personality disorders;

(6)__Paraphilias;

(7)__Attention-deficit and disruptive behavior disorders;

(8)__Pervasive developmental disorders;

(9)__Tic disorders;

(10)__Eating disorders, including bulimia and anorexia; and

(11)__Substance abuse-related disorders.

K.__"Outpatient care" means care rendered by a state- licensed practitioner; 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.

L.__"Outpatient services" includes, but is not limited to, screening, evaluation, consultation, diagnosis and treatment involving use of psychoeducational, physiological, psychological and psychosocial evaluative and interventive concepts, techniques and processes provided to individuals and groups.

M.__"Person suffering from a mental illness" means a person whose psychobiological processes are impaired severely enough to manifest problems in the areas of social, psychological or biological functioning. Such a person has a disorder of thought, mood, perception, orientation or memory that impairs judgment, behavior, capacity to recognize or ability to cope with the ordinary demands of life.__A person suffering from a mental illness manifests an impaired capacity to maintain acceptable levels of functioning in the areas of intellect, emotion or physical well-being.

N.__"Preexisting condition" means a condition existing during a specified period immediately preceding the effective date of coverage that would have caused an ordinary prudent person to seek medical advice, diagnosis, care or treatment or a condition for which medical advice, diagnosis, care or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.

O.__"Preexisting condition provision" means a provision in a health benefit plan that denies, excludes or limits benefits for an enrollee for expenses or services related to a preexisting condition.

P.__"Provider" means those individuals included in Title 24- A, section 2744, subsection 1, and a licensed physician, an accredited public hospital or psychiatric hospital or a community agency licensed at the comprehensive service level by the Department of Mental Health, Mental Retardation and Substance Abuse Services.__All agency or institutional providers named in this paragraph__shall ensure that services are supervised by a psychiatrist, licensed psychologist or master's level clinician, licensed in this State to practice at the independent level and who meets the Department of Mental Health, Mental Retardation and Substance Abuse Services standards for the provision of supervision.

Q.__"Residential treatment" means services at a facility that provides care 24 hours daily to one or more patients, including, but not limited to, the following services: 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 and all other services specified in this paragraph to a person suffering from a mental illness.

R.__"Treatment" means services, including diagnostic evaluation; medical, psychiatric and psychological care; and psychotherapy for mental illness rendered by a hospital, alcohol or drug rehabilitation facility, intermediate care facility, mental health treatment center or a professional, pursuant to Title 24-A, section 2744, subsection 1, and licensed in the State to diagnose and treat conditions defined in the Diagnostic and Statistical Manual of Mental Disorders, as periodically revised.

Sec. 5. 24 MRSA §2325-A, sub-§§4 and 5, as enacted by PL 1983, c. 515, §4, are amended to read:

4. Requirement. Every nonprofit hospital or medical service organization which that issues individual or 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 person covered under those contracts for conditions arising from mental illness. The requirements of this section apply to every health benefit plan that provides coverage for a family member of the insured or the subscriber that is offered, renewed, amended, executed, continued, delivered or issued for delivery in this State to an employer or individual on an individual or group basis.

5. Services. Each individual or group contract shall must provide, at a minimum, for the following benefits for a person suffering from a mental or nervous condition:

A. Inpatient care treatment and services;

B. Day treatment services; and

C. Outpatient care, treatment and services.;

D.__Home support services; and

E.__Residential treatment.

Sec. 6. 24 MRSA §2325-A, sub-§5-A, as amended by PL 1989, c. 490, §1, is repealed.

Sec. 7. 24 MRSA §2325-A, sub-§5-C, as amended by PL 1995, c. 637, §1, is further amended to read:

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

A. All individual or 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 illness diagnosed by a licensed allopathic or osteopathic physician, a person included in Title 24-A, section 2744, subsection 1 or a licensed psychologist who is trained and has received a doctorate in psychology specializing in the evaluation and treatment of human behavior: mental illness.

(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.

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 equal to 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 or psychiatric treatment for mental illness shall furnish data substantiating that initial or continued treatment is medically or psychiatrically necessary and appropriate. When making the determination of whether treatment is medically or psychiatrically 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.

(3)__The benefits and coverage required under this subsection must be provided as one set of benefits, and coverage covering mental illness must have the same terms and conditions as the benefits and coverage for physical illness covered under the policy or contract, and may be delivered under a managed care system.

(4)__A policy or contract may not have separate maximums for physical illness and mental illness, separate deductibles and coinsurance amounts for physical illness and mental illness, separate out-of- pocket limits in a benefit period of not more than 12 months for physical illness and mental illness or separate office visitation limits for physical illness and mental illness.

(5)__A health benefit plan may not impose a limitation on coverage or benefits for mental illness unless that same limitation is also imposed on the coverage and benefits for physical illness covered under the policy or contract.

(6)__Copayments required under a policy or contract for benefits and coverage for mental illness must be actuarially equivalent to any coinsurance requirements or, if there are no coinsurance requirements, not greater than any copayment required under the policy or contract for a benefit or coverage for a physical illness.

(7)__A health benefit plan may not limit coverage for a preexisting condition that is a mental illness.

(8)__For the purposes of this section, medication management visits associated with a mental illness must be covered in the same manner as a medication management visit for the treatment of a physical illness and may not be counted in the calculation of any maximum outpatient treatment visit limits.

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. 8. 24 MRSA §2325-A, sub-§5-D, as amended by PL 1995, c. 637, §2, is repealed.

Sec. 9. 24 MRSA §2325-A, sub-§7, as enacted by PL 1983, c. 515, §4, is amended to read:

7. Limits; coinsurance; deductibles. Any policy or contract which that provides coverage for the services required by this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions only to the extent that these provisions are not inconsistent with the requirements of this section maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions are equal to those established for physical illness and conform with the requirements of subsection 5-C.

Sec. 10. 24 MRSA §2325-A, sub-§10 is enacted to read:

10.__Transition.__The provisions of this section do not limit the provision of specialized services for individuals with mental illness who are covered by Medicaid, supersede the provisions of federal law, federal or state Medicaid policy or the terms and conditions imposed on any Medicaid waiver granted to the State with respect to the provision of services to individuals with mental illness, and affect any annual health insurance plan until its date of renewal or any health insurance plan governed by a collective bargaining agreement or employment contract until the expiration of that contract.

Sec. 11. 24 MRSA §2329, sub-§1, as repealed and replaced by PL 1983, c. 527, §1, is repealed.

Sec. 12. 24 MRSA §2329, sub-§1-A is enacted to read:

1-A.__Policy and purpose.__The Legislature recognizes that alcoholism and drug dependency constitute major health problems in the State and in the Nation and declares that it is the policy of the State to:

A.__Require that every health benefit plan that is offered, amended, delivered, continued, executed, issued for delivery or renewed in this State provide coverage and benefits for the coverage of alcoholism and drug dependency equal to or exceeding the coverage and benefits available under health benefit plans for the diagnosis and treatment of all other physical illnesses to ensure equitable and nondiscriminatory health coverage benefits for all forms of illness, including

alcoholism and drug dependency, which are of significant consequence to the health of the citizens of the State, and which can be treated in a cost-effective manner;

B.__Recognize that alcoholism is a disease and that alcoholism and drug dependency can be effectively treated.__ As such, alcoholism and drug dependency warrant the same attention from the health care industry as other serious diseases and illnesses.__The Legislature further recognizes that health care contracts, at times, fail to provide adequate benefits for the treatment of alcoholism and drug dependency, which results in more costly health care for treatment of complications caused by the lack of early intervention and other treatment services for persons suffering from these illnesses.__This situation causes higher health care, social, law enforcement and economic costs to the citizens of this State than is necessary, including the need for the State to provide treatment to some subscribers at public expense; and

C.__Declare that, to assist the many citizens of this State who suffer from these illnesses in a more cost-effective way, health care coverage benefits for the treatment of the illnesses of alcoholism and drug dependency must be included in all individual and group health care contracts and must include coverage for inpatient treatment, outpatient treatment, residential treatment, crisis intervention and resolution care, maximum lifetime benefits, copayments, coverage of home visits, individual and family deductibles and coinsurance.

Sec. 13. 24 MRSA §2329, sub-§2, as amended by PL 1987, c. 735, §41, is repealed.

Sec. 14. 24 MRSA §2329, sub-§2-A is enacted to read:

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

A.__"Health benefit plan" means:

(1)__Policies, contracts or certificates for hospital or medical benefits that are offered, renewed, amended, executed, continued, delivered or issued for delivery in this State to an employer or individual on an individual or group basis or on an individual or group subscription basis and that provide coverage for residents of this State;

(2)__Nonprofit hospital or medical service organization indemnity plans;

(3)__Health maintenance organization subscriber or group master contracts;

(4)__Preferred provider plans;

(5)__Health benefit plans offered or administered by the State or by any subdivision or instrumentality of the State;

(6)__Multiple-employer welfare arrangements or associations located in this State or another state and that cover residents of this State who are eligible employees; or

(7)__Employer self-insured plans that are not exempt pursuant to the federal Employee Retirement Income Security Act of 1974 provisions.

"Health benefit plan" does not include accident-only insurance, fixed indemnity insurance, credit health insurance, Medicare supplement policies, Civilian Health and Medical Program of the Uniformed Services supplement policies, long-term care insurance, disability income insurance, workers' compensation or similar insurance; disease-specific insurance, automobile medical payment insurance, dental insurance or vision insurance.

B.__"Outpatient care" means care rendered by a state- licensed practitioner; 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; crisis intervention and resolution; and educational and support services.

C.__"Preexisting condition" means a condition existing during a specified period immediately preceding the effective date of coverage that would have caused an ordinary prudent person to seek medical advice, diagnosis, care or treatment or a condition for which medical advice, diagnosis, care or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.

D.__"Preexisting condition provision" means a provision in a

health benefit plan that denies, excludes or limits benefits for an enrollee for expenses or services related to a preexisting condition.

E.__"Residential treatment" means services at a facility that provides care 24 hours daily to one or more patients, including, but not limited to, the following services:__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 and all other services specified in this paragraph to patients with the illnesses of alcoholism and drug dependency.

F.__"Treatment plan" means a written plan initiated at the time of admission, approved by a licensed physician, a person included in Title 24-A, section 2744, subsection 1 who can demonstrate expertise in addictions or a licensed or registered alcohol and drug counselor employed by a certified or licensed substance abuse program.__"Treatment plan" includes, but is 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.

Sec. 15. 24 MRSA §2329, sub-§§3 and 4, as enacted by PL 1983, c. 527, §1, are amended to read:

3. Requirement. Every nonprofit hospital or medical service organization which that issues individual or 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 person covered under those contracts for the treatment of alcoholism and other drug dependency pursuant to a treatment plan. The requirements of this section apply to every health benefit plan that provides coverage for a family member of the insured or the subscriber and that is offered, renewed, amended, executed, continued, delivered or issued for delivery in this State to an employer or individual on an individual or group basis.

4. Services; providers. Each individual or group contract shall provide, at a minimum, for the following coverage, pursuant to a treatment plan:

A. Residential treatment at a hospital or free-standing residential treatment center which is licensed, certified or approved by the State; and

B. Outpatient care, including crisis intervention and resolution, rendered by state licensed, certified or approved providers who have contracted with the nonprofit hospital or medical service organization under terms and conditions which the organization deems satisfactory to its membership consistent with the requirements of this section.

Treatment or confinement at any facility shall not preclude further or additional treatment at any other eligible facility, provided that the benefit days used do not exceed the total number of benefit days provided for under the contract.

4-A.__Contract requirements.__All policies, contracts and certificates, delivered, issued for delivery, continued or renewed in this State must provide benefits that meet the requirements of this subsection.__For purposes of this subsection, all contracts are deemed renewed no later than the next yearly anniversary of the contract date.

A.__The contracts must provide benefits for the treatment and diagnosis of alcoholism and drug dependency under terms and conditions that are equal to the benefits provided for medical treatment for physical illness.

B.__At the request of a nonprofit hospital or medical service organization, a provider of treatment for alcoholism or drug dependency shall furnish data substantiating that initial or continued treatment is necessary and appropriate.__ When making the determination of whether treatment is necessary and appropriate, the provider shall use the same criteria for medical treatment for alcoholism and drug dependency as for medical treatment for physical illness under the contract.

C.__The benefits and coverage required under this section must be provided as one set of benefits and coverage covering alcoholism and drug dependency, must have the same terms and conditions as the benefits and coverage for physical illness covered under the policy or contract and may be delivered under a managed care system.

D.__A policy or contract may not have separate maximums for physical illnesses and alcoholism and drug dependency, separate deductibles and coinsurance amounts for physical illness and alcoholism and drug dependency covered under

this section, separate out-of-pocket limits in a benefit period of not more than 12 months for physical illness and alcoholism and drug dependency or separate office visitation limits for physical illness and alcoholism and drug dependency.

E.__A health benefit plan may not impose a limitation on coverage or benefits for alcoholism and drug dependency unless that same limitation is also imposed on the coverage and benefits for physical illness covered under the policy or contract.

F.__Copayments required under a policy or contract for benefits and coverage for alcoholism and drug dependency must be actuarially equivalent to any coinsurance requirements, or if there are no coinsurance requirements, not greater than any copayment required under the policy or contract for a benefit or coverage for a physical illness.

G.__A health benefit plan may not limit coverage for a preexisting condition that is alcoholism or drug dependency.

H.__For the purposes of this section, medication management visits associated with alcoholism and drug dependency must be covered in the same manner as a medication management visit for the treatment of a physical illness and may not be counted in the calculation of any maximum outpatient treatment visit limits.

Sec. 16. 24 MRSA §2329, sub-§5, as amended by PL 1989, c. 490, §2, is repealed.

Sec. 17. 24 MRSA §2329, sub-§6, as enacted by PL 1983, c. 527, §1, is amended to read:

6. Limits; coinsurance; deductibles. Any policy or contract which that provides coverage for the services required by this section may contain provisions for maximum benefits and coinsurance, and reasonable limitations, deductibles and exclusions only to the extent that these provisions are not inconsistent with maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions are equal to those established for physical illness and conform to the requirements of this section subsection 4-A.

Sec. 18. 24 MRSA §2329, sub-§11 is enacted to read:

11.__Transition.__The provisions of this section do not limit the provision of specialized services for individuals with alcoholism or drug dependency who are covered by Medicaid, supersede the provisions of federal law, federal or state

Medicaid policy or the terms and conditions imposed on any Medicaid waiver granted to the State with respect to the provision of services to individuals with alcoholism or drug dependency, and affect any annual health insurance plan until its date of renewal or any health insurance plan governed by a collective bargaining agreement or employment contract until the expiration of that contract.

Sec. 19. 24-A MRSA §2744, as amended by PL 1995, c. 561, §2, is further amended to read:

§2744. Mental health services

1. Notwithstanding any provision of a health insurance policy subject to this chapter, whenever the policy provides for payment or reimbursement for services which that are within the lawful scope of practice of a psychologist licensed to practice in this State, a certified social worker licensed for the independent practice of social work in this State who has at least a masters degree in social work from an accredited educational institution, has been employed in social work for at least 2 years, and who, after January 1, 1985, must be licensed as a clinical social worker in this State, or a licensed clinical professional counselor licensed for the independent practice of counseling who has at least a masters degree in counseling from an accredited educational institution, has been employed in counseling for at least 2 years and, after January 1, 2002, must be licensed as a clinical professional counselor in this State, or a licensed nurse who is certified by the American Nurses' Association as a clinical specialist in adult psychiatric and mental health nursing or as a clinical specialist in child and adolescent psychiatric and mental health nursing, any person covered by the policy shall be is entitled to reimbursement for these services if the services are performed by a physician, a psychologist licensed to practice in this State, a certified social worker licensed for the independent practice of social work who has at least a masters degree in social work from an accredited educational institution, who has been employed in social work for at least 2 years, and who, after January 1, 1985, must be licensed as a clinical social worker in this State, or a licensed clinical professional counselor licensed for the independent practice of counseling who has at least a masters degree in counseling from an accredited educational institution, has been employed in counseling for at least 2 years and, after January 1, 2002, must be licensed as a clinical professional counselor in this State, or a licensed nurse certified by the American Nurses' Association as a clinical specialist in adult or child and adolescent psychiatric and mental health nursing. With respect to services provided by physicians or psychologists, this This section applies to all health insurance policies, contracts

or certificates issued, renewed, modified, altered, amended or reissued on or after July 1, 1975. Payment or reimbursement for services rendered by clinical social workers licensed in this State shall, licensed clinical professional counselors licensed in this State or licensed nurses certified by the American Nurses' Association as clinical specialists in adult or child and adolescent psychiatric and mental health nursing may not be conditioned upon prior diagnosis or referral by a physician or other health care professional, except in cases where diagnosis of the condition for which the services are rendered is beyond the scope of their licensure.

2. Nothing in subsection 1 may be construed to require a health insurance policy subject to this chapter to provide for reimbursement of services which are within the lawful scope of practice of a psychologist licensed to practice in this State, a clinical social worker licensed in this State, a certified social worker licensed to practice in this State, or a certified nurse licensed to practice in this State.

3. Mental health services provided by counseling professionals. An insurer that issues individual health care contracts providing coverage for mental health services shall offer coverage for those services when performed by a counseling professional who is licensed by the State pursuant to Title 32, chapter 119 to assess and treat interpersonal and intrapersonal problems, has at least a masters degree in counseling or a related field from an accredited educational institution and has been employed as a counselor for at least 2 years. Any contract providing coverage for the services of counseling professionals pursuant to this section may be subject to any reasonable limitations, maximum benefits, coinsurance, deductibles or exclusion provisions applicable to overall benefits under the contract. This subsection applies to all contracts executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 1997. For purposes of this subsection, all contracts are deemed renewed no later than the next yearly anniversary of the contract date.

Sec. 20. 24-A MRSA §2749-C, sub-§1, as amended by PL 1995, c. 637, §3, is further amended to read:

1. Coverage for treatment for mental illnesses. Coverage for medical treatment for mental illnesses listed in paragraph A by all individual policies is subject to this section.

A. All individual policies must make available coverage providing provide, at a minimum, benefits according to paragraph B, subparagraph (1) for a person receiving medical or psychiatric treatment for any of the following mental

illnesses for which diagnostic criteria are prescribed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, as periodically revised, and 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:, or an individual included in section 2744, subsection 1.

(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.

B. All individual policies and contracts executed, delivered, issued for delivery, continued or renewed in this State on or after July 1, 1996 must make available provide coverage providing 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 offer of coverage must provide benefits for the treatment and diagnosis of mental illnesses under terms and conditions that are no less extensive than equal to the benefits provided for medical treatment for physical illnesses.

(2) At the request of a reimbursing insurer, a provider of medical or psychiatric treatment for mental illness shall furnish data substantiating that initial or continued treatment is medically or psychiatrically necessary and appropriate. When making the determination of whether treatment is medically or psychiatrically 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 individual policy.

(3)__The benefits and coverage required under this section must be provided as one set of benefits, and

coverage covering mental illness must have the same terms and conditions as the benefits and coverage for physical illness covered under the policy or contract and may be delivered under a managed care system.

(4)__A policy or contract may not have separate maximums for physical illness and mental illness, separate deductibles and coinsurance amounts for physical illness and mental illness, separate out-of- pocket limits in a benefit period of not more than 12 months for physical illness and mental illness or separate office visitation limits for physical illness and mental illness.

(5)__A health benefit plan may not impose a limitation on coverage or benefits for mental illness unless that same limitation is also imposed on the coverage and benefits for physical illnesses covered under the policy or contract.

(6)__Copayments required under a policy or contract for benefits and coverage for mental illness must be actuarially equivalent to any coinsurance requirements or, if there are no coinsurance requirements, not greater than any copayment required under the policy or contract for a benefit or coverage for a physical illness.

(7)__A health benefit plan may not limit coverage for a preexisting condition that is a mental illness.

(8)__For the purposes of this section, medication management visits associated with a mental illness must be covered in the same manner as a medication management visit for the treatment of a physical illness and may not be counted in the calculation of any maximum outpatient treatment visit limits.

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. 21. 24-A MRSA §2749-C, sub-§§2 and 3, as enacted by PL 1995, c. 407, §5, are amended to read:

2. Contracts; providers. Subject to approval by the superintendent pursuant to section 2305, an insurer incorporated under this chapter shall offer contracts to providers, pursuant to section 2744, authorizing the provision of mental health services within the scope of the provider's licensure.

3. Limits; coinsurance; deductibles. A 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 only to the extent that these provisions are not inconsistent with the requirements of this section maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions are equal to those established for physical illness and conform with requirements of subsection 1, paragraph B.

Sec. 22. 24-A MRSA §2749-C, sub-§6 is enacted to read:

6.__Transition.__The provisions of this section do not limit the provision of specialized services for individuals with mental illness who are covered by Medicaid, supersede the provisions of federal law, federal or state Medicaid policy or the terms and conditions imposed on any Medicaid waiver granted to the State with respect to the provision of services to individuals with mental illness, and affect any annual health insurance plan until its date of renewal or any health insurance plan governed by a collective bargaining agreement or employment contract until the expiration of that contract.

Sec. 23. 24-A MRSA §2835, as amended by PL 1995, c. 561, §3, is further amended to read:

§2835. Mental health services

1. Notwithstanding any provision of a health insurance policy subject to this chapter, whenever the policy provides for payment or reimbursement for services which that are within the lawful scope of practice of a psychologist licensed to practice in this State, a certified social worker licensed for the independent practice of social work in this State who has at least a masters degree in social work from an accredited educational institution, has been employed in social work for at least 2 years, and who, after January 1, 1985, must be licensed as a clinical social worker in this State, or a licensed clinical professional counselor licensed for the independent practice of counseling who has at least a masters degree in counseling from an accredited educational institution, has been employed in counseling for at least 2 years and, after January 1, 2002, must be licensed as a clinical professional counselor in this State, or a licensed nurse who is certified by the American Nurses' Association as a clinical specialist in adult psychiatric and mental health nursing or as a clinical specialist in child and adolescent psychiatric and mental health nursing, any person covered by the policy shall be is entitled to reimbursement for these services if the services are performed by a physician, a psychologist licensed to practice in this State, certified social

worker licensed for independent practice in this State who has at least a masters degree in social work from an accredited educational institution, who has been employed in social work for at least 2 years, and who, after January 1, 1985, must be licensed as a clinical social worker in this State, or a licensed clinical professional counselor licensed for the independent practice of counseling who has at least a masters degree in counseling from an accredited educational institution, has been employed in counseling for at least 2 years and, after January 1, 2002, must be licensed as a clinical professional counselor in this State, or a licensed nurse certified by the American Nurses' Association as a clinical specialist in adult or child and adolescent psychiatric and mental health nursing. With respect to services provided by physicians or psychologists, this section applies to all health insurance policies, contracts or certificates issued, renewed, modified, altered, amended or reissued on or after April 16, 1976. Payment or reimbursement for services rendered by clinical social workers licensed in this State shall, licensed clinical professional counselors licensed in this State or licensed nurses certified by the American Nurses' Association as clinical specialists in adult or child and adolescent psychiatric and mental health nursing may not be conditioned upon prior diagnosis or referral by a physician or other health care professional, except in cases where diagnosis of the condition for which the services are rendered is beyond the scope of their licensure.

2. Nothing in subsection 1 may be construed to require a health insurance policy subject to this chapter to provide for reimbursement of services which are within the lawful scope of practice of a psychologist licensed to practice in this State, a clinical social worker licensed in this State, a certified social worker licensed to practice in this State, or a nurse certified and licensed to practice in this State.

3. Mental health services provided by counseling professionals. An insurer that issues group health care contracts providing coverage for mental health services shall make available coverage for those services when performed by a counseling professional who is licensed by the State pursuant to Title 32, chapter 119 to assess and treat interpersonal and intrapersonal problems, has at least a masters degree in counseling or a related field from an accredited educational institution and has been employed as a counselor for at least 2 years. Any contract providing coverage for the services of counseling professionals pursuant to this section may be subject to any reasonable limitations, maximum benefits, coinsurance, deductibles or exclusion provisions applicable to overall benefits under the contract. This subsection applies to all contracts executed, delivered, issued for delivery, continued or

renewed in this State on or after January 1, 1997. For purposes of this subsection, all contracts are deemed renewed no later than the next yearly anniversary of the contract date.

Sec. 24. 24-A MRSA §2842, sub-§1, as repealed and replaced by PL 1983, c. 527, §2, is repealed.

Sec. 25. 24-A MRSA §2842, sub-§1-A is enacted to read:

1-A.__Policy and Purpose. The Legislature recognizes that alcoholism and drug dependency constitute major health problems in the State and in the Nation and declares that it is the policy of the State to:

A.__Require that every health benefit plan that is offered, amended, delivered, continued, executed, issued for delivery or renewed in this State provide coverage and benefits for the coverage of alcoholism and drug dependency equal to or exceeding the coverage and benefits available under health benefit plans for the diagnosis and treatment of all other covered physical illnesses to ensure equitable and nondiscriminatory health coverage benefits for all forms of illness, including alcoholism and drug dependency, which are of significant consequence to the health of the citizens of the State, and which can be treated in a cost-effective manner;

B.__Recognize that alcoholism is a disease and that alcoholism and drug dependency can be effectively treated. As such, alcoholism and drug dependency warrant the same attention from the health care industry as other serious diseases and illnesses. The Legislature further recognizes that health care contracts, at times, fail to provide adequate benefits for the treatment of alcoholism and drug dependency, which results in more costly health care for treatment of complications caused by the lack of early intervention and other treatment services for persons suffering from these illnesses. This situation causes higher health care, social, law enforcement and economic costs to the citizens of this State than is necessary, including the need for the State to provide treatment to some insureds at public expense; and

C.__Declare that, to assist the many citizens of this State who suffer from these illnesses in a more cost-effective way, health insurance coverage benefits for the treatment of the illnesses of alcoholism and drug dependency must be included in all group health care contracts and must include coverage for inpatient treatment, outpatient treatment, residential treatment, crisis intervention and resolution

care, maximum lifetime benefits, copayments, coverage of home visits, individual and family deductibles and coinsurance.

Sec. 26. 24-A MRSA §2842, sub-§2, as repealed and replaced by PL 1983, c. 527, §2, is repealed.

Sec. 27. 24-A MRSA §2842, sub-§2-A is enacted to read:

2-A.__Definitions. As used in this section, unless the context indicates otherwise, the following terms have the following meanings.

A.__"Health benefit plan" means:

(1)__Policies, contracts or certificates for hospital or medical benefits that are offered, renewed, amended, executed, continued, delivered or issued for delivery in this State to an employer on a group basis or on a group subscription basis, and that provides coverage for residents of this State;

(2)__Nonprofit hospital or medical service organization indemnity plans;

(3)__Health maintenance organization group master contracts;

(4)__Preferred provider plans;

(5)__Health benefit plans offered or administered by the State or by any subdivision or instrumentality of the State;

(6)__Multiple-employer welfare arrangements or associations located in this State or another state and that cover residents of this State who are eligible employees; or

(7)__Employer self-insured plans that are not exempt pursuant to the federal Employee Retirement Income Security Act of 1974 provisions.

"Health benefit plan" does not include accident-only insurance, fixed indemnity insurance, credit health insurance, Medicare supplement policies, Civilian Health and Medical Program of the Uniformed Services supplement policies, long-term care insurance, disability income insurance, workers' compensation or similar insurance, disease-specific insurance, automobile medical payment insurance, dental insurance or vision insurance.

B.__"Outpatient care" means care rendered by a state- licensed practitioner; 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; crisis intervention and resolution; and educational and support services.

C.__"Preexisting condition" means a condition existing during a specified period immediately preceding the effective date of coverage that would have caused an ordinary prudent person to seek medical advice, diagnosis, care or treatment or a condition for which medical advice, diagnosis, care or treatment or a condition for which medical advice, diagnosis, care or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.

D.__"Preexisting condition provision" means a provision in a health benefit plan that denies, excludes or limits benefits for an enrollee for expenses or services related to a preexisting condition.

E.__"Residential treatment" means services at a facility that provides care 24 hours daily to one or more patients, including, but not limited to, the following services: 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 and all other services specified in this paragraph to patients with the illnesses of alcoholism and drug dependency.

F.__"Treatment plan" means a written plan initiated at the time of admission, approved by a licensed physician, a person included in section 2744, subsection 1 who can demonstrate expertise in addictions or a licensed or registered alcohol and drug counselor employed by a certified or licensed substance abuse program.__"Treatment plan" includes, but is 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.

Sec. 28. 24-A MRSA §2842, sub-§§3 and 4, as enacted by PL 1983, c. 527, §2, are amended to read:

3. Requirement. Every 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 person covered under those contracts for the treatment of alcoholism and other drug dependency pursuant to a treatment plan. The requirements of this section apply to every health benefit plan that provides coverage for a family member of the insured and that is offered, renewed, amended, executed, continued, delivered or issued for delivery in this State to an employer or policyholder on a group basis.

4. Services; providers. Each grop group contract shall provide, at a minimum, for the following coverage, pursuant to a treatment plan:

A. Residential treatment at a hospital or free-standing residential treatment center which that is licensed, certified or approved by the State; and

B. Outpatient care rendered by state licensed, certified or approved providers.

Treatment or confinement at any facility shall not preclude further or additional treatment at any other eligible facility, provided that the benefit days used do not exceed the total number of benefit days provided for under the contract.

Sec. 29. 24-A MRSA §2842, sub-§5, as amended by PL 1989, c. 490, §3, is repealed.

Sec. 30. 24-A MRSA §2842, sub-§6, as enacted by PL 1983, c. 527, §2, is amended to read:

6. Limits; coinsurance; deductibles. Any policy or contract which that provides coverage for the services required by this section may contain provisions for maximum benefits and coinsurance, and reasonable limitations, deductibles and exclusions only to the extent that these provisions are not inconsistent with the requirements of this section maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions are equal to those established for physical illness and conform to the requirements of subsection 4.

Sec. 31. 24-A MRSA §2842, sub-§11 is enacted to read:

11.__Transition.__The provisions of this section do not

limit the provision of specialized services for individuals with alcoholism or drug dependency who are covered by Medicaid, supersede the provisions of federal law, federal or state Medicaid policy or the terms and conditions imposed on any Medicaid waiver granted to the State with respect to the provision of services to individuals with alcoholism or drug dependency, and affect any annual health insurance plan until its date of renewal or any health insurance plan governed by a collective bargaining agreement or employment contract until the expiration of that contract.

Sec. 32. 24-A MRSA §2843, sub-§1, ¶C, as enacted by PL 1983, c. 515, §6, is repealed and the following enacted in its place:

C.__Typical health coverage in this State continues to discriminate against mental illness and those coping with such illnesses despite repeated efforts to mandate equal coverage.__Discrimination takes the form of limiting or denying coverage, with nonexistent or limited benefits compared to provisions for other illnesses that are not limited or denied; and

Sec. 33. 24-A MRSA §2843, sub-§2, ¶¶A and B, as enacted by PL 1983, c. 515, §6, are amended to read:

A. Promote Require that every health benefit plan that is offered, amended, delivered, continued, executed, issued for delivery or renewed in this State, provide coverage and benefits for the coverage of mental illness equal to or exceeding the coverage and benefits available under health benefit plans for the diagnosis and treatment of all other covered physical illnesses and to ensure equitable and nondiscriminatory health coverage benefits for all forms of illness, including mental and emotional disorders, which are of significant consequence to the health of Maine people and which can be treated in a cost effective manner;

B. Assure that victims of mental and other illnesses have access to and choice of appropriate treatment at the earliest point of illness in least restrictive settings, including coverage for inpatient treatment, outpatient treatment, day treatment, outpatient care, residential treatment, home support services, crisis intervention and resolution care, medication, maximum lifetime benefits, copayments, coverage of home visits, individual and family deductibles and coinsurance;

Sec. 34. 24-A MRSA §2843, sub-§3, as amended by PL 1995, c. 560, Pt. K, §82 and affected by §83, is repealed.

Sec. 35. 24-A MRSA §2843, sub-§3-A is enacted to read:

3-A.__Definitions.__For purposes of this section, unless the context otherwise indicates, the following terms have the following meanings.

A.__"Adult" means any person who is 18 years of age or older.

B.__"Child" means any person under 18 years of age.

C.__"Day treatment services" includes psychoeducational, physiological, psychological and psychosocial concepts, techniques and processes necessary to maintain or develop functional skills of clients, provided to individuals or groups for periods of more than 2 hours but less than 24 hours per day.

D.__"Health benefit plan" means:

(1)__Policies, contracts or certificates for hospital or medical benefits that are offered, renewed, amended, executed, continued, delivered or issued for delivery in this State to an employer or policy holder on a group basis or on a group subscription basis, and that provide coverage for residents of this State;

(2)__Nonprofit hospital or medical service organization indemnity plans;

(3)__Health maintenance organization group master contracts;

(4)__Preferred provider plans;

(5)__Health benefit plans offered or administered by the State or by any subdivision or instrumentality of the State;

(6)__Multiple-employer welfare arrangements or associations located in this State or another state and that cover residents of this State who are eligible employees; or

(7)__Employer self-insured plans that are not exempt pursuant to the__federal Employee Retirement Income Security Act of 1974 provisions.

"Health benefit plan" does not include accident-only insurance, fixed indemnity insurance, credit health

insurance, Medicare supplement policies, Civilian Health and Medical Program of the Uniformed Services supplement policies, long-term care insurance, disability income insurance, workers' compensation or similar insurance, disease-specific insurance, automobile medical payment insurance, dental insurance or vision insurance.

E.__"Home support services" means rehabilitative services, treatment services and living skills services provided for a person with a mental illness.__"Home support services" may be provided in a community setting or the person's current place of residence, and are services that promote the integration of the person into the community, sustain the person in the person's current living situation or another living situation of that person's choosing and enhance the person's quality of life. "Home support services" may be provided directly to the person or indirectly through collateral contact or by telephone contact or other means on behalf of the person.__"Home support services" includes, but is not limited to:

(1)__Case management services and assertive community treatment services;

(2)__Medication education and monitoring;

(3)__Crisis intervention and resolution services and follow-up services; and

(4)__Individual, group and family counseling services.

F.__"Inpatient services" includes, but is not limited to, a range of physiological, psychological and other intervention concepts, techniques and processes in a community mental__ health psychiatric inpatient unit, general hospital psychiatric unit or psychiatric hospital licensed by the Department of Human Services or accredited public hospital to restore psychosocial functioning sufficient to allow maintenance and support of a person suffering from a mental illness in a less restrictive setting.

G.__"Inpatient treatment" means mental health or substance abuse services delivered on a 24-hour per day basis in a hospital, accredited public hospital, alcohol or drug rehabilitation facility, intermediate care facility, community mental health psychiatric inpatient unit, general hospital psychiatric unit or psychiatric hospital licensed by the Department of Human Services.

H.__"Intermediate care facility" means a licensed,

residential public or private facility that is not a hospital and that is operated primarily for the purpose of providing a continuous, structured 24-hour per day, state- approved program of inpatient substance abuse services.

I.__"Mental health services" means treatment for mental illnesses.

J.__"Mental illness" is any mental or nervous condition that affects a person by impairing the person's psychobiological processes severely enough that the person manifests problems in the areas of social, psychological or biological functioning.__A person with mental illness has a disorder of thought, mood, perception, orientation or memory that impairs judgment, behavior, capacity to recognize or ability to cope with the ordinary demands of life.__A person with mental illness manifests an impaired capacity to maintain acceptable levels of functioning in the areas of intellect, emotion or physical well-being.__"Mental illness" includes, but is not limited to, any of the following illnesses for which the diagnostic criteria are prescribed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, as periodically revised, as the illness applies to adults and children:

(1)__Psychotic disorders, including schizophrenia;

(2)__Dissociative disorders;

(3)__Mood disorders;

(4)__Anxiety disorders;

(5)__Personality disorders;

(6)__Paraphilias;

(7)__Attention-deficit and disruptive behavior disorders;

(8)__Pervasive developmental disorders;

(9)__Tic disorders;

(10)__Eating disorders, including bulimia and anorexia; and

(11)__Substance abuse-related disorders.

K.__"Outpatient care" means care rendered by a

state-licensed practitioner; 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.

L.__"Outpatient services" includes, but is not limited to, screening, evaluation, consultations, diagnosis and treatment involving use of psychoeducational, physiological, psychological and psychosocial evaluative and interventive concepts, techniques and processes provided to individuals and groups.

M.__"Person suffering from a mental illness" means a person whose psychobiological processes are impaired severely enough to manifest problems in the areas of social, psychological or biological functioning. Such a person has a disorder of thought, mood, perception, orientation or memory that impairs judgment, behavior, capacity to recognize or ability to cope with the ordinary demands of life.__A person suffering from a mental illness manifests an impaired capacity to maintain acceptable levels of functioning in the areas of intellect, emotion or physical well-being.

N.__"Preexisting condition" means a condition existing during a specified period immediately preceding the effective date of coverage that would have caused an ordinary prudent person to seek medical advice, diagnosis, care or treatment or a condition for which medical advice, diagnosis, care or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.

O.__"Preexisting condition provision" means a provision in a health benefit plan that denies, excludes or limits benefits for an enrollee for expenses or services related to a preexisting condition.

P.__"Provider" means those individuals included in section 2744, subsection 1, and a licensed physician, an accredited public hospital or psychiatric hospital or a community agency licensed at the comprehensive service level by the Department of Mental Health, Mental Retardation and Substance Abuse Services.__All agencies or institutional providers named in this paragraph shall ensure that services are supervised by a psychiatrist, licensed psychologist, or master's level clinician, licensed in this State to practice at the independent level, who meets the Department of Mental Health, Mental Retardation and Substance Abuse Services standards for the provision of supervision.

Q.__"Residential treatment" means services at a facility that provides care 24 hours daily to one or more patients, including, but not limited to, the following services: 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 and all other services specified in this paragraph to a person suffering from a mental illness.

R.__"Treatment" means services, including diagnostic evaluation; medical, psychiatric and psychological care; and psychotherapy for mental illnesses rendered by a hospital, alcohol or drug rehabilitation facility, intermediate care facility, mental health treatment center or a professional, pursuant to section 2744, subsection 1 and licensed in the State to diagnose and treat conditions defined in the Diagnostic and Statistical Manual of Mental Disorders, as periodically revised.

Sec. 36. 24-A MRSA §2843, sub-§4, as enacted by PL 1983, c. 515, §6, is amended to read:

4. Requirement. Every 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 person covered under those contracts for conditions arising from mental illness. The requirements of this section shall apply to every health benefit plan that provides coverage for a family member of the insured or the subscriber that is offered, renewed, amended, executed, continued, delivered or issued for delivery in this State to an employer or policyholder on a group basis.

Sec. 37. 24-A MRSA §2843, sub-§5, as enacted by PL 1983, c. 515, §6, is amended to read:

5. Services. Each group contract shall must provide, at a minimum, for the following benefits for a person suffering from a mental or nervous condition:

A. Inpatient care treatment and services;

B. Day treatment services; and

C. Outpatient care, treatment and services.;

D.__Home support services; and

E.__Residential treatment.

Sec. 38. 24-A MRSA §2843, sub-§5-A, as amended by PL 1989, c. 490, §4, is repealed.

Sec. 39. 24-A MRSA §2843, sub-§5-C, as amended by PL 1995, c. 637, §4, is further amended to read:

5-C. Coverage for treatment for 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 or psychiatric treatment for any of the following mental illnesses defined in subsection 3-A, paragraph J, 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;, or an individual included in section 2744, subsection 1.

(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.

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 equal to the benefits provided for medical treatment for physical illnesses.

(2) At the request of a nonprofit hospital or medical service organization an insurer, a provider of medical or psychiatric treatment for mental illness shall furnish data substantiating that initial or continued treatment is medically or psychiatrically necessary and appropriate. When making the determination of whether treatment is medically or psychiatrically 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.

(3)__The benefits and coverage required under this section must be provided as one set of benefits, and coverage covering mental illness must have the same terms and conditions as the benefits and coverage for physical illness covered under the policy or contract and may be delivered under a managed care system.

(4)__A policy or contract may not have separate maximums for physical illness and mental illness, separate deductibles and coinsurance amounts for physical illness and mental illness, separate out-of-pocket limits in a benefit period of not more than 12 months for physical illness and mental illness or separate office visitation limits for physical illness and mental illness.

(5)__A health benefit plan may not impose a limitation on coverage or benefits for mental illness unless that same limitation is also imposed on the coverage and benefits for physical illness covered under the policy or contract.

(6)__Copayments required under a policy or contract for benefits and coverage for mental illness must be actuarially equivalent to any coinsurance requirements or, if there are no coinsurance requirements, not greater than any copayment required under the policy or contract for a benefit or coverage for a physical illness.

(7)__A health benefit plan may not limit coverage for a preexisting condition that is a mental illness.

(8)__For the purposes of this section, medication management visits associated with a mental illness must be covered in the same manner as a medication management visit for the treatment of a physical illness and may not be counted in the calculation of any maximum outpatient treatment visit limits.

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.