LD 1319
pg. 386
Page 385 of 423 An Act Making Unified Appropriations and Allocations for the Expenditures of St... Page 387 of 423
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LR 2000
Item 1

 
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. Every nonprofit hospital and medical services service
organization and nonprofit health care plan must make
available coverage in all individual and group policies,
contracts and certificates executed, delivered, issued for
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


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