LD 566
pg. 7
Page 6 of 20 An Act to Ensure Equality in Mental Health Coverage Page 8 of 20
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LR 22
Item 1

 
subparagraph (1) for a person receiving medical or
psychiatric 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 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 individual policies and contracts executed,
delivered, issued for delivery, continued or renewed in
this State on or after July 1, 1996 must make available
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
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 or psychiatric treatment for mental
illness as for medical treatment for physical illness
under the individual policy.

 
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.


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