LD 1319
pg. 423
Page 422 of 460 PUBLIC Law Chapter 20 Page 424 of 460
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LR 2000
Item 1

 
treatment for mental illnesses listed in paragraph A by all
individual and group nonprofit hospital and medical services
service organization health care plan contracts is subject to
this subsection.

 
A. All individual and group contracts must make available
coverage providing, at a minimum, benefits according to
paragraph B, subparagraph (1) for a person receiving medical
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. 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
treatment for mental illness shall furnish data
substantiating that initial or continued treatment is
medically necessary and appropriate health care. When
making the determination of whether treatment is


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