LD 566
pg. 16
Page 15 of 20 An Act to Ensure Equality in Mental Health Coverage Page 17 of 20
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LR 22
Item 1

 
(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.

 
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 reimbursing health
maintenance 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 or psychiatric treatment
for mental illness as for medical treatment for
physical
illness under the group contract.


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