LD 1319
pg. 434
Page 433 of 460 PUBLIC Law Chapter 20 Page 435 of 460
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LR 2000
Item 1

 
State on or after July 1, 1996 must provide 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 contracts 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 health maintenance
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 medically
necessary and appropriate health care, the provider
shall use the same criteria for medical treatment for
mental illness as for medical treatment for physical
illness under the group contract.

 
(3) If benefits and coverage for the treatment of
physical illness are provided on an expense-incurred
basis, the benefits and coverage required under this
subsection may be delivered separately under a managed
care system.

 
(4)__A policy or contract may not have separate
maximums for physical illness and mental illness,
separate deductibles and coinsurance amounts for
physical illness and mental illness, separate out-of-
pocket limits in a benefit period of not more than 12
months for physical illness and mental illness or
separate office visit limits for physical illness and
mental illness.

 
(5)__A health benefit plan may not impose a limitation
on coverage or benefits for mental illness unless that
same limitation is also imposed on the coverage and
benefits for physical illness covered under the policy
or contract.

 
(6)__Copayments required under a policy or contract for
benefits and coverage for mental illness must be
actuarially equivalent to any coinsurance requirements
or, if there are no coinsurance requirements, may not
be greater than any copayment or coinsurance required
under the policy or contract for a benefit or coverage
for a physical illness.


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