LD 1319
pg. 430
Page 429 of 460 PUBLIC Law Chapter 20 Page 431 of 460
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LR 2000
Item 1

 
Sec. VV-15. 24-A MRSA §2843, sub-§5-D, as amended by PL 1995, c. 637,
§5, is further amended to read:

 
5-D. Mandated offer of coverage for certain mental illnesses.
Except as otherwise provided in subsection 5-C, coverage for
medical treatment for mental illnesses listed in paragraph A by
all group contracts is subject to this subsection.

 
A. All 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. All group policies, contracts and certificates 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 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


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