LD 566
pg. 6
Page 5 of 20 An Act to Ensure Equality in Mental Health Coverage Page 7 of 20
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LR 22
Item 1

 
delivery, continued or renewed in this State on or after
July 1, 1996 that provides benefits meeting 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
the benefits provided for medical treatment for
physical illnesses.

 
(2) At the request of a nonprofit hospital or and
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 or psychiatric treatment
for mental illness as for medical treatment for
physical illness under the individual or group
contract.

 
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. 7. 24 MRSA §2325-A, sub-§6, as enacted by PL 1983, c. 515, §4,
is amended to read:

 
6. Contracts; providers. Subject to the approval by the
Superintendent of Insurance pursuant to section 2305, a
nonprofit hospital or and a medical service organization
incorporated under this chapter shall offer contracts to
providers, including those listed in Title 24-A, sections 2744
and 2835, subsection 1, authorizing the provision of mental
health services within the scope of the provider's licensure.

 
Sec. 8. 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 certain mental illnesses.
Coverage for medical or psychiatric 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, at a minimum, benefits according to paragraph B,


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