An Act to Ensure Equality in Mental Health Coverage
Maine Legislature, Session 121, LD 0566
Committee: Health and Human Services
Sponsors: DUDLEY
Amends: 24 MRSA §2325-A, 24-A MRSA §2749-C, 24-A MRSA §2843, 24-A MRSA §4234-A, 24-A MRSA §4234

Legislative Document 
No. 566 
H.P.429 
House of Representatives, February 11,2003 
An Act to Ensure Equality in Mental Health Coverage 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Representative DUDLEY of Portland. 
7Y/~ 
111.7lbc~ 
MILLICENT M. MacFARLAND 
Clerk 
Under suspension of the rules, cosponsored by President DAGGETT of Kennebec and 
Representatives: ADAMS of Portland, ASH of Belfast, BARSTOW of Gorham, 
BLANCHETTE of Bangor, BLISS of South Portland, BRANNIGAN of Portland, BREAULT 
of Buxton, BULL of Freeport, BUNKER of Kossuth Township, CANAVAN of Waterville, 
CLARK of Millinocket, Speaker COLWELL of Gardiner, COWGER of Hallowell, 
CUMMINGS of Portland, DUGA Y of Cherryfield, DUNLAP of Old Town, DUPLESSIE of 
Westbrook, EARLE of Damariscotta, EDER of Portland, FAIRCLOTH of Bangor, FINCH of 
Fairfield, FISCHER of Presque Isle, GAGNE-FRIEL of Buckfield, GERZOFSKY of 
Brunswick, GOODWIN of Pembroke, GREELEY of Levant, HATCH of Skowhegan, 
HUTTON of Bowdoinham, KANE of Saco, KOFFMAN of Bar Harbor, LANDRY of Sanford, 
Additional cosponsors on next page 
Printed on recycled paper 
LA VERRIERE-BOUCHER of Biddeford, LEMOINE of Old Orchard Beach, LERMAN of 
Augusta, LESSARD of Topsham, MAILHOT of Lewiston, MAKAS of Lewiston, MARLEY 
of Portland, MARRACHE of Waterville, McGLOCKLIN of Embden, McGOWAN of 
Pittsfield, McKEE of Wayne, McLAUGHLIN of Cape Elizabeth, McNEIL of Rockland, 
MILLETT of Waterford, NORBERT of Portland, NORTON of Bangor, O'BRIEN of Augusta, 
O'BRIEN of Lewiston, O'NEIL of Saco, PARADIS of Frenchville, PATRICK of Rumford, 
PERCY of Phippsburg, PERRY of Calais, PERRY of Bangor, PINEAU of Jay, PINGREE of 
North Haven, PIOTTI of Unity, RICHARDSON of Brunswick, RINES of Wiscasset, 
ROGERS of Brewer, SAMPSON of Auburn, SIMPSON of Auburn, SMITH of Monmouth, 
SMITH of Van Buren, SULLIVAN of Biddeford, SUSLOVIC of Portland, THOMAS of 
Orono, THOMPSON of China, TWOMEY of Biddeford, WALCOTT of Lewiston, WATSON 
of Bath, WHEELER of Kittery, WOODBURY of Yarmouth, WOTTON of Littleton, Senators: 
BRENNAN of Cumberland, BROMLEY of Cumberland, BRYANT of Oxford, CATHCART 
of Penobscot, DAMON of Hancock, DOUGLASS of Androscoggin, EDMONDS of 
Cumberland, GAGNON of Kennebec, HALL of Lincoln, HATCH of Somerset, 
LafOUNTAIN of York, LEMONT of York, MARTIN of Aroostook, PENDLETON of 
Cumberland, ROTUNDO of Androscoggin, SAWYER of Penobscot, STANLEY of Penobscot, 
STRIMLING of Cumberland, TREAT of Kennebec. 
Printed on recycled paper 
• 
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• 
• 
• 
• 
• 
• 
Be it enacted by the People of the State of Maine as follows: 
Sec. I. 24 MRSA §2325-A, sub-§3, 1JA-I is enacted to read: 
A 1. 
"Home support services" means rehabilitative services, 
treatment services and living skills services provided for a 
person with a mental illness. 
"Home support services" may 
be provided in a community setting or the person's current 
place of 
residence, 
and 
are 
services 
that 
promote 
the 
integration of the person into the community, sustain the 
person in the person's current living situation or another 
living situation of that person's choosing and enhance the 
person's g:uality of life. 
"Home support services" may be 
provided 
directly 
to 
the 
person 
or 
indirectly 
through 
collateral contact or by telephone contact or other means on 
behalf of the person. 
"Home support services" includes, but 
is not limited to: 
(1) 
Case management services and assertive community 
treatment services; 
(2) 
Medication education and monitoring; 
(3) 
Crisis intervention and resolution services and 
follow-up services; and 
(4) 
Individual, group and family counseling services. 
Sec. 2. 24 MRSA §2325-A. sub-§3. -un, as enacted by PL 1983, c. 
515, §4, is amended to read: 
D. 
"Person suffering from a mental eF--ne-r"--v<>-u6--€eaEli1:iea 
illness" means a person whose psychobiological processes are 
impaired severely enough to manifest problems in the areas 
of social, psychological or biological functioning. Such a 
person 
has 
a 
disorder 
of 
thought, 
mood, 
perception, 
orientation or memory wsies that impairs judgment, behavior, 
capacity to recognize or ability to cope with the ordinary 
demands of life. 
The person manifests an impaired capacity 
to maintain acceptable levels of functioning in the areas of 
intellect, emotion or physical well-being. 
Sec. 3. 24 MRSA §2325-A. sub-§3.1JF is enacted to read: 
F. 
"Residential treatment services" means services at a 
facili ty that provides care 24 hours daily to one or more 
patients, 
including, 
but 
not 
limited to, 
the 
following 
services: 
room 
and 
board; 
medical, 
nursing 
and 
dietary 
services; 
patient 
diagnosis, 
assessment 
and 
treatment; 
individual, family and group counseling; and educational and 
support services, including a designated unit of a licensed 
health care facility providing any other services specified 
in this paragraph to 
a 
person suffering 
from 
a 
mental 
illness. 
Sec. 4. 24 MRS A §2325-A, sub-§§4 and 5, as enacted by PL 1983, 
c. 515, §4, are amended to read: 
4. 
Requirement. 
Every nonprofit hospital at and medical 
service 
organization 
waiea 
that 
issues 
group 
health 
care 
contracts providing coverage t;et--ho-&p-i-t-a-1--eate to residents of 
this State shall provide benefits as required in this section to 
any subscriber or other person covered under those contracts for 
conditions arising from mental illness. 
5. 
Services. 
Each group contract saa~~ must provide, at a 
m~n~mum, for the following benefits for a person suffering from a 
mental aF-aeFye~S-eeaai~iaa illness: 
A. 
Inpatient care; 
B. 
Day treatment services; aaa 
C. 
Outpatient servicesTL 
D. 
Home support services; and 
E. 
Residential treatment services. 
Sec. 5. 24 MRSA §2325-A, sub-§5-C, as amended by PL 1995, c. 
625, Pt. B, §6 and affected by §7 and amended by c. 637, §l, is 
further amended to read: 
5-C. 
Coveraqe for treatment for certain mental 
Coverage for medical treatment for mental illnesses 
paragraph -A- A-I is subject to this subsection. 
illnesses. 
listed in 
AT--A~~-~~~~~~~~~~~-~~~r~~-e-ffii:ai:ffi~ffir-eeaet;iE6 
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• 
• 
• 
• 
• 
• 
• 
~4}--Pal:'a:aeiaf 
~9}--Pa:aie-Qiser,Qel:'f 
A 1. 
All 
group 
contracts 
must 
provide, 
at 
a 
minimum, 
benefits according to paragraph a, subparagraph (1) for a 
person receiving medical or psychiatric treatment for any of 
the following categories of mental illness diagnosed by a 
licensed allopathic or osteopathic physician, 
a 
licensed 
psychologist who is trained and has received a doctorate in 
psychology specializing in the evaluation and treatment of 
mental illness: 
(1) 
Psychotic disorders, including schizophrenia; 
(2) 
Dissociative disorders; 
(3) 
Mood disorders; 
(4) 
Anxiety disorders; 
(5) 
Personality disordersj 
(6) 
Paraphilias; 
Attention 
defici t 
and 
disruptive 
behavior 
disorders; 
(8) 
Pervasive developmental disorders; 
(9) 
Tic disorders; 
(10) 
Eating disorders, including bulimia and anorexia; 
and 
(11) 
Substance abuse-related disorders. 
B. 
All 
policies, 
contracts 
and 
certificates 
executed, 
delivered, issued for delivery, continued or renewed in this 
State 
e:a-~--a-:&1::e-F--J-Q.,l2'--1-r-±9ge 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 
nonprofit hospital 
9!' 
anQ 
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 
group contract. 
(3) 
If benefits and coverage for 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 
visitation 
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 reguired under a policy or contract for 
benefits 
and 
coverage 
for 
mental 
illness 
must 
be 
actuarially eguivalent to any coinsurance reguirements 
or, 
if there 
are 
no 
coinsurance 
reguirements, 
not 
greater than any copayment required under the policy or 
contract for 
a 
benefit or 
coverage 
for 
a 
physical 
illness. 
{7} 
For 
the 
purposes 
of 
this 
section, 
medication 
management visits associated with a mental illness must 
be 
covered 
in 
the 
same 
manner 
as 
a 
medication 
management 
visit 
for 
the 
treatment 
of 
a 
physical 
'., 
• 
• 
• 
• 
• 
illness and may not be counted in the calculation of 
any maximum outpatient treatment visit limits. 
This 
subsection 
does 
not 
apply 
to 
policies, 
contracts 
and 
certificates covering employees of employers with 20 or fewer 
employees, whether the group policy is issued to the employer, to 
an association, to a multiple-employer trust or to another entity. 
±Ris--&~&&ee~iea-~~-~-~-~~~~-~~-a~~ew--eeve~a~e--aaa 
&eaeEi~s--~~---ERe--~~~~---eE--~~~~--eE--~~---aEH~ 
ae~eaaeaeies-~h£e~~h-~~~~~-ef-a-~~-~~~-~~&~-ia 
~aEa~Ea~R--A-T 
Sec. 6. 24 MRSA §2325-A, sub-§5-D, as amended by PL 1995, c. 
637, §2, is further amended to read: 
5-D. 
Mandated 
offer 
of 
coverage 
for 
certain 
mental 
illnesses. 
Except as otherwise provided, coverage for medical or 
psychiatric treatment for mental illnesses listed in paragraph A 
by all 
individual 
and 
group 
nonprofit 
hospital 
and 
medical 
seEviees 
service 
organization health 
care 
plan 
contracts 
1S 
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 
or psychiatric treatment for 
any of the following mental 
illnesses diagnosed by a licensed allopathic or osteopathic 
physician e~L a licensed psychologist who is trained and has 
received 
a 
doctorate 
in 
psychology 
specializing 
in 
the 
evaluation and treatment of R~maa-&eRavie~ 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 
se~viees 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 9B---0-l:'--a,€l;;ef' 
J~±Y-±T-1999 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. 
must provide benefits for 
of mental illnesses under 
are no less extensive than 
for 
medical 
treatment 
for 
(1) 
The offer of coverage 
the treatment and diagnosis 
terms and conditions that 
the 
benefits 
provided 
physical illnesses. 
(2) 
At the request of a 
nonprofit hospital 9F 
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 
dependencies through the diaanosis of a mental illness listed in 
paragraph A. 
Sec. 7. 24 MRSA §2325-A. sub-§6. as enacted by PL 1983, 
c. 
515, §4, is amended to read: 
6. 
Contracts; providers. 
Subject to the approval by the 
Superintendent of Insurance pursuant to section 2305, a nonprofit 
hospital 9F and a medical service organization incorporated under 
this chapter shall offer contracts to providers, including those 
listed in Title 24-A, 
sections 
2744 
and 
2835, 
subsection 
1, 
authorizing the provision of mental health services within the 
scope of the provider's licensure. 
Sec. 8. 24-A MRSA §2749-C. sub-§l. as amended by PL 1995, c. 
637, §3, is further amended to read: 
1. 
Coverage for treatment for certain mental illnesses_ 
Coverage 
for 
medical 
or 
psychiatric 
treatment 
for 
mental 
illnesses listed in paragraph A by all individual policies is 
subject to this section. 
A. 
All individual policies must make available coverage 
providing, at a minimum, benefits according to paragraph S, 
.. 
• 
• 
• 
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 eEL a licensed psychologist who is trained and has 
received 
a 
doctorate 
in psychology 
specializing in the 
evaluation and treatment of R~ffiaR-BeRay~eE 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 eR-e~-~~~-~~-~r-±999 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. 
Sec. 9. 24-A MRSA §2749-C, sub-§2, as enacted by PL 1995, c. 
407, §5, is amended to read: 
2. 
Contracts; 
providers. 
g~aje€~--~~-~~~-~y--tRe 
s~~e~iRteReeRt---~~Fs~aRt--~~--~~~--~~~~7---aR 
An 
insurer 
incorporated 
under 
this 
chapter 
shall 
offer 
contracts 
to 
providers, 
including those providers listed in section 2744, 
subsection 1, authorizing the provision of mental health services 
within the scope of the provider's licensure. 
Sec.lO. 24-A MRSA §2843, sub-§3, 1rA-l is enacted to read: 
A-l. 
"Home support services" means rehabili tati ve services, 
treatment services and living skills services provided for a 
person with a mental illness. 
"Home support services" may 
be provided in a community setting or the person's current 
place 
of 
residence, 
and 
are 
services 
that 
promote 
the 
integration of the person into the community, sustain the 
person in the person's current living situation or another 
living situation of that person's choosing and enhance the 
person's guality of life. 
"Home support services" may be 
provided 
directly 
to 
the 
person 
or 
indirectly 
through 
collateral contact or by telephone contact or other means on 
behalf of the person. 
"Home support services" includes, but 
is not limited to: 
(1) 
Case management services and assertive communi ty 
treatment services; 
(2) 
Medication education and monitoring; 
(3) 
Crisis intervention and resolution services and 
follow-up services; and 
(4) 
Individual, group and family counseling services. 
Sec. 11. 24-A MRSA §2843. sub-§3. 1rD. as enacted by PL 1983, 
c. 515, §6, is amended to read: 
D. 
"Person suffering from 
a 
mental 
eF--ne-r-~-€EH~El,i,tieR 
illness" means a person whose psychobiological processes are 
impaired severely enough to manifest problems in the areas 
of social, psychological or biological functioning. 
Such a 
person 
has 
a 
disorder 
of 
thought, 
mood, 
perception, 
orientation or memory wRieR that impairs judgment, behavior, 
capacity to recognize or ability to cope with the ordinary 
demands of life. 
The person manifests an impaired capacity 
to maintain acceptable levels of functioning in the areas of 
intellect, emotion or physical well-being. 
• 
• 
• 
• 
• 
Sec. 12. 24-A MRSA §2843, sub-§3, 1rF is enacted to read: 
F. 
"Residential tr-eatment services" means services at a 
facility that provides care 24 hours daily to one or more 
patients, 
including, 
but 
not 
limited to, 
the 
following 
services: 
room 
and 
board: 
medical. 
nursing 
and 
dietary 
services; 
patient 
diagnosis. 
assessment 
and 
treatment; 
individual. family and group counseling; and educational and 
support services. including a designated unit of a licensed 
health care facility providing any other services specified 
in this paragraph to 
a 
person suffering 
from 
a 
mental 
illness. 
Sec. 13. 24-A MRSA §2843, sub-§§4 and 5, as enacted by PL 1983, 
c. 515, §6, are amended to read: 
4. 
Requirement. 
Every 
insurer 
wAieA 
that issues 
group 
health care contracts providing coverage 
~et:--ho-sp-.:i:-t.-a-l--eat:e to 
residents of this State shall provide benefits as required in 
this section to any subscriber or other person covered under 
those contracts for conditions arising from mental illness. 
5. 
Services. 
Each group contract 6Aall must provide, at a 
minimum, for the following benefits for a person suffering from a 
mental e~-ge~ve~6-eegeitieg illness: 
A. 
Inpatient care; 
B. 
Day treatment services; age 
C. 
Outpatient servicesTL 
D. 
Home support services; and 
E. 
Residential treatment services. 
Sec. 14. 24-A MRS A §2843. sub-§5-C. as amended by PL 1995. c. 
625, Pt. B, §8 and affected by §9 and amended by c. 637, §4, is 
further amended to read: 
5-C. 
Coverage 
illnesses 
Coverage for treatment for certain mental illness_ 
for 
medical 
or 
psychiatric 
treatment 
for 
mental 
listed 
in 
paragraph --A-
A-I 
is 
subject 
to 
this 
subsection. 
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aeee~eig~--~-~~~-~--6~9pa~a~~apA--~~~-~~--~--~e~6eg 
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illge66e6-~~~~-a-±i€eg6ee-~~~~~~~-e6tee~atAie 
pRysieiaB-e~-~-~~-p&yeae~~i&~-WRe-~~-~~~~-aaG-Ba6 
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eva±~a~ieB-aBa-~~ea~ffieB~-e€-B~ffiaB-beBavie~+ 
A-I. 
All 
group 
contracts 
must 
provide, 
at 
a 
minimum~ 
benefits according to paragraph a, subparagraph (1) for a 
person receiving medical or psychiatric treatment for any of 
the following categories of mental illness diagnosed by a 
licensed allopathic or osteopathic physician, 
a 
licensed 
psychologist who is trained and has received a doctorate in 
psychology specializing in the evaluation and treatment of 
mental illness: 
(1) 
Psychotic disorders, including schizophrenia; 
(2) 
Dissociative disorders L 
(3) 
Mood disorders; 
(4) 
Anxiety disorders; 
(5) 
Personality disorders; 
(6) 
Paraphilias; 
(7) 
Attention 
deficit 
and 
disruptive 
behavior 
disorders; 
(8) 
Pervasive developmental disorders; 
(9) 
Tic disorders; 
(10) 
Eating disorders, including bulimia and anorexia2 
and 
(11) 
Substance abuse-related disorders. 
• 
• 
• 
B. 
All 
policies, 
contracts 
and 
certificates 
executed, 
delivered, issued for delivery, continued or renewed in this 
State 
eR-~--a~t,.e.F--J-I:I..,ly--:b-r-199§ 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-£~£~~~~~-~1t~:b-~F--meaiea± 
se~yiee-~~~aRi~a~ieR 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 group contract. 
(3) 
If benefits and coverage provided for treatment of 
physical illness are pro-.-ided 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 , 
se12arate 
out-of-pocket limits in a benefit period of not more 
than 12 months for 12hysical illness and mental illness 
or 
separate 
office 
visitation 
limits 
for 
physical 
illness and mental illness. 
(5) 
A health benefit 12lan 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 
re<:.ll!ir~L1Jnder a policy or contract for 
benefits 
and 
coverage 
for 
mental 
illness 
must 
be 
actuarially equivalent to any coinsurance requirements 
Page ll-LR0022(1) 
or, 
if there 
are 
no 
coinsurance 
requirements, 
not 
greater than any copayment required under the policy or 
contract for 
a 
benefit or 
coverage 
for 
a 
physical 
illness. 
(7) 
For 
the 
purposes 
of 
this 
section, 
medication 
management visits associated with a mental illness must 
be 
covered 
in 
the 
same 
manner 
as 
a 
medication 
management 
visit 
for 
the 
treatment 
of 
a 
physical 
illness and may not be counted in the calculation of 
any maximum outpatient treatment visit limits. 
This 
subsection 
does 
not 
apply 
to 
policies, 
contracts 
and 
certificates covering employees of employers with 20 or fewer 
employees, whether the group policy is issued to the employer, to 
an association, to a mUltiple-employer trust or to another entity. 
±Ri6--&~a&ee&iea-~~-~-~-~~~-~~-~~~~w--€eve£a~e--aRa 
aeaeEi&6--~~---&Re--~~~~---eE--~I~~I~~--e£--~~---a£~~ 
ae~eRaeReie6-~£~~~~£-~~~~~-9f-a-~~-~~~-~~&B&G-iR 
~a£a~£a~R--AT 
Sec. 15. 24·A MRS A §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 
otherwiso 
provided 
in 
subsection 
5-C, 
coverage 
for 
medical 
QL_-I?_s.y~hiatric: 
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 
Q..£ 
Q§ychiatric 
treatment 
for 
any 
of 
the 
following 
mental 
illnesses diagnosed by a licensed allopathic or osteopathic 
physician orL 
a licensed psychologist who is trained and has 
received 
a 
doctorate 
in 
psychology 
specializing 
in 
the 
evaluation and treatment of R~ffiaR-aeRavie£ 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 ea-e~-~~~-~~-~r-±9ge 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. 
must provide benefits for 
of mental illnesses under 
are no less extensive than 
for 
medical 
treatment 
for 
(1) 
The offer of coverage 
the treatment and diagnosis 
terms and conditions that 
the 
benefits 
provided 
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 group contract. 
JO 
This 
subsection may 
not 
be 
construed 
to 
allow coverage 
and 
benefi ts 
for 
the 
treatment 
of 
alcoholism 
and 
other 
drug 
dependencies through the diagnosis of a mental illness listed in 
paragraph A. 
Sec. 16. 24-A MRSA §4234-A. sub-§3.1fA-l is enacted to read: 
A-I. 
"Home support services" means rehabili tati ve services, 
treatment services and living skills services provided for a 
person with a mental illness. 
"Home support services" may 
be provided in a community setting or the person's current 
place 
of 
residence, 
and 
are 
services 
that 
promote 
the 
integration of the person into the community, sustain the 
person in the person's current living situation or another 
living situation of that person' s 
choosir::.g and enhance the 
person's g:uality of life. 
"Home support services" may be 
provided 
directly 
to 
the 
person 
or 
indirectly 
through 
collateral contact or by telephone contact or other means on 
behalf of the person. 
"Home support services" includes, but 
is not limited to: 
(1) 
Case management services and assertive community 
treatment services: 
(2) 
Medication education and monitoring; 
(3) 
Crisis intervention and resolution services and 
follow-up services; and 
(4) 
Individual, group and family counseling services~ 
Sec. 17. 24-A MRSA §4234-A, sub-§3, ,D, as enacted by PL 1995, 
c. 407, §10, is amended to read: 
D. 
"Person suffering from 
a 
mental 
e~---n€-i':"~-€eBEl,i,t;,i,eB 
illness" means a person whose psychobiological processes are 
impaired severely enough to manifest problems in the area of 
social, 
psychological 
or 
biological 
functioning. 
Such 
a 
person 
has 
a 
disorder 
of 
thought, 
mood, 
perception, 
orientation 
or 
memory 
that 
impairs 
judgment, 
behavior, 
capacity to recognize or ability to cope with the ordinary 
demands of life, 
The person manifests an impaired capacity 
to maintain acceptable levels of functioning in the area of 
intellect, emotion or physical well-being. 
Sec. IS. 24-A MRSA §4234~A, sub-§3. ~ is enacted to read: 
F. 
"Residential treatment sen'ices" means 
services at 
a 
facili ty that provides care 24 hours daily to one or more 
patients, 
including, 
but 
not 
limited 
to, 
the 
following 
services: 
room 
and 
board; 
medical, 
nursing 
and 
dietary 
services; 
patient 
diagnosis, 
assessment 
and 
treatment; 
individual, family and group counseling; and educational and 
support services, including a designated unit of a licensed 
health care facility providing any other services specified 
in this paragraph 
to 
a 
person suffering 
from 
a 
mental 
illness. 
Sec. 19. 24-A MRSA §4234-A. sub-§§4 and 5, as enacted by PL 
1995, c. 407, §10, are amended to read: 
4. 
Requirement. 
Every health maintenance organization that 
issues 
individual 
or 
group 
health 
care 
contracts 
providing 
coverage 
feF--be6p,i,t;a~--eaFe to 
residents of this State shall 
provide benefits as required in this section to any subscriber or 
other person covered under those contracts for conditions arising 
from mental illness. 
5. 
provide, 
suffering 
Services. 
Each 
individual 
or 
group 
contract 
must 
at 
a 
minimum, 
the 
following benefits 
for 
a 
person 
from a mental eF-Berve~s-eeBElitiea illness: 
• 
, 
• 
• 
.. 
A. 
Inpatient services; 
B. 
Day treatment services; aad 
C. 
Outpatient servicesT~ 
D. 
Home support services; and 
E. 
Residential treatment services. 
Sec. 20. 24-A MRSA §4234-A, sub-§6, as amended by PL 1995, c. 
637, §6, is further amended to read: 
6. 
Coverage 
for 
treatment of certain mental 
illnesses . 
Coverage 
for 
medical 
or 
psychiatric 
treatment 
for 
mental 
illnesses 
listed 
in 
paragraph --A-
A-I 
is 
subject 
to 
this 
subsection. 
AT--All-~~e~~-~~~~~~-~-~~i~,~-&-ffiiRiffiaffir-aeaefi~6 
aeeetdia~--~-~~~~-~--6aa~ata~ta~a--~~~-~~--~--~etsea 
teeeivia~-me~~~~~-~~~~--~~-aay-e~-~~-~~~w~~-mea~a± 
i±±aes6es-~~B4-~-a-~~€eR£ea-~~~~~~~-e6~ee~a~aie 
Fay6ieiaa-e~-~-~ic~-F&yeae±~i&~-wae-~~-~~~~-aad-aa6 
teeeived--a--deeEetaEe--ia--~6yeae±e~y--6~eeia±isia~--ia--Eae 
eva±aaEiea-aad-EteaEmeat-ef-aamaa-aeaaviet+ 
{-4t--Pataaeiaf 
A-I. 
All 
group 
contracts 
must 
provide, 
at 
a 
minimum, 
benefits according to paragraph B, subparagraph (1) for 
q 
person receiving medical or psychiatric treatment for any of 
the following categories of mental illness diagnosed by a 
licensed allopathic or osteopathic physician, 
a 
licensed 
psychologist who is trained and has received a doctorate in 
psychology specializing in the evaluation and treatment of 
mental illness: 
Page l5-LR0022(1) 
(1) 
Psychotic disorders, including schizophrenia; 
(2) 
Dissociative disorders; 
(3) 
Mood disorders; 
(4) 
Anxiety disorders; 
(5) 
Personality disorders; 
(6) 
Paraphilias; 
(7) 
Attention 
deficit 
and 
disruptive 
behavior 
disorders; 
(8) 
Pervasive developmental disorders; 
(9) 
Tic disorders; 
(10) 
Eating disorders, including bulimia and anorexia; 
and 
(11) 
Substance abuse-related disorders. 
B. 
All 
policies, 
contracts 
and 
certificates 
executed, 
delivered, issued for delivery, continued or renewed in this 
State 9B--&r--aE-t:-e-F-J-u-ly--1-.--19ge 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 
or 
psychiatric 
treatment 
for 
mental 
illness 
shall 
furnish 
data 
substantiating that initial or continued treatment 
lS 
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 
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 
visitation 
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, 
not 
greater than any copayment required under the policy or 
contract for 
a 
benefit or 
coverage 
for 
a 
physical 
illness. 
(7) 
For 
the 
purposes 
of 
this 
section, 
medication 
management visits associated with a mental illness must 
be 
covered 
in 
the 
same 
manner 
as 
a 
medication 
management 
visit 
for 
the 
treatment 
of 
a 
physical 
illness and may not be counted in the calculation of 
any maximum outpatient treatment visit limits. 
This 
subsection 
does 
not 
apply 
to 
policies, 
contracts 
or 
certificates covering employees of employers with 20 or fewer 
employees, whether the group policy is issued to the employer, to 
an association, to a mUltiple-employer trust or to another entity. 
~Ris--&aa&ee~iea-~ay-~~-~-~~~~-~~-~~~€w--€e¥e£a~e--aRe 
:eeRe~ il:s __ .f~- _ -1:-$ - _ -t£ea-tmeR-t- - -D-f- - -aleeHeli&ffi - -~-fl.€J.- - -o-t-he-r- - -eFy.~ 
aeFeaaeaeies-~£~€~~£-~~~~~-ef-a-~~--~~~-li&B&G-iR 
FaFa~FaFR-AT 
Sec. 21. 24-A MRSA §4234-A. sub-§7. as amended by PL 1995, c. 
637, §7, is further amended to read: 
7. 
Mandated 
offer 
of 
coverage 
for 
certain 
mental 
illnesses. 
Except as provided in subsection 6, 
coverage for 
medical or psychiatric treatment for mental illnesses listed in 
paragraph A by all individual and group 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 
or psychiatric treatment for any of the following mental 
illnesses diagnosed by a licensed allopathic or osteopathic 
physician eFL a licensed psychologist who is trained and has 
received 
a 
doctorate 
in 
psychology 
specializing 
in 
the 
evaluation and treatment of a~ffiaB-beaa¥ieF 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 
and 
group 
policies, 
contracts 
and 
certificates 
executed, 
delivered, 
issued 
for 
delivery, 
continued or renewed in this State eB-B~-~~~-~~-~r-±99§ 
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 health maintenance 
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 
appropr iate. 
When making the determination of , .... hether 
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 
benefi ts 
for 
the 
treatment 
of 
alcoholism 
and 
other 
drug 
dependencies through the diagnosis of a mental illness listed in 
paragraph A. 
Sec. 22. 24-A MRSA §4234-A, sub-§8, as enac ted by PL 1995, c. 
407, §10, is amended to read: 
8. 
Contracts; 
providers. 
Subject 
to 
approval 
by 
the 
superintendent pursuant to section 4204, 
a health maintenance 
organization 
incorporated 
under 
this 
chapter 
shall 
allow 
providers, including those listed in subsection 8-A or sections 
2744 or 2835, subsection L 
to contract, subject to the health 
maintenance 
organization's 
credentialling 
policy, 
for 
the 
provision of mental health services within the scope of the 
provider's licensure. 
Sec. 23. 24-A MRSA §4234-A. sub-§8-A, as enacted by PL 1997, 
c. 174, §l, is amended to read: 
8-A. 
Mental 
health 
services 
provided 
by 
counseling 
professionals. 
A health maintenance organization that issues 
individual or group health care contracts providing coverage for 
mental health serVlces shall eEEeF provide coverage for those 
services 
when 
performed by 
a 
counseling professional 
who 
is 
licensed by the State pursuant to Title 32, chapter 119 te-asse66 
aaa-~~€~~-~~~~~~-aad-iatFa¥eFseaal-~B~€ffi£~-~-a~-lea6t 
a--ma6teF6-~~--~-~~~-~--~-~€J~~~--~JeJB--E£em--aB 
aeeFeaitea--eaHeatieaal--iastitHtiea--aaa--Ras--eeea--em¥leyea--as 
eeHaseleF-~B~-~--~-b-yeaFs. 
Any contract providing coverage 
for the services of counseling professionals pursuant to this 
subsection may be subject to any reasonable limitations, maximum 
benefits, 
coinsurance, 
deductibles 
or 
exclusion 
provisions 
applicable 
to 
overall 
benefits 
under 
the 
contract. 
'IRis 
sHeseetieB-~~~-~~-~~~-~~~~~-e*e€~~ea7-~~~~r-issHea 
EeF-~~~~r-€BB~JB~eB--&F-~~-ia-~~~-~~a~e--&&-~--aEteF 
J aBHaFY - -l~ - ...,l-9-9-&-.- - -F-o-r- -¥HF¥9s-es- - et - -t.fH.-6- --s-ubtre-c~-ion-,- -al-l--eeat F ae t s 
aFe-~-~~-&e-Ja~e~-~~-~he-aeK~-~...,l~~~V&~~~-eE 
tRe-eeatFae~-aa~eT 
Sec. 24. 24-A MRSA §4234-A. sub-§ll. as amended by PL 1995, c. 
673, Pt. D, §8, is further amended to read: 
11. 
Application. 
Except 
as 
otherwise 
provided, 
the 
requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued 
or renewed in this State 9R--an4--a-:E-t;e.F--J"-H.J.y--1-,-19ge. 
Contracts 
entered into with the State Government or the Federal Government 
to 
service 
Medicaid 
or 
Medicare 
populations 
may 
limit 
the 
services provided under such contracts consistent with the terms 
of those contracts if mental health services are provided to 
these populations by other means. 
For purposes of this section, 
all contracts are deemed renewed no later than the next yearly 
anniversary of the contract date. 
Sec. 25. Application. 
The requirements 
all policies, 
contracts 
and certificates 
issued for delivery, continued or renewed 
after the effective date of this Act. 
For 
all contracts are deemed to be renewed no 
yearly anniversary of the contract date. 
SUMMARY 
of this Act apply to 
executed, 
delivered, 
in this State on or 
purposes of this Act, 
later than the next 
This bill requires parity coverage for mental illnesses for 
all health benefit plans covering groups of 21 or more. 
The bill 
expands the coverage of mental illness to include 11 categories 
of mental illness as defined in the Diagnostic and Statistical 
Manual of Mental Disorders, as periodically revised, and allows 
that coverage to be delivered as a carve out under a managed care 
system. 
The bill requires coverage for residential treatment 
services and home support services. 
The provisions apply to all 
policies 
and 
contracts 
issued 
or 
renewed 
on 
or 
after 
the 
effective date of this bill. 
The bill makes no change to the 
mandated offer of parity requirement for individual plans and 
group plans covering fewer than 20 persons under current law. 
•