An Act To Require That Mental Health Workers with Family Therapist Licenses Be Recognized as Licensed Professionals for Purposes of Insurance Reimbursement
Maine Legislature, Session 122, LD 0028
Committee: Insurance and Financial Services
Sponsors: GLYNN, DUDLEY
Amends: 24-A MRSA §2744

Legislative Document 
No.2S 
H.P.31 
House of Representatives, January 6,2005 
An Act To Require That Mental Health Workers with Family 
Therapist Licenses Be Recognized as Licensed Professionals for 
Purposes of Insurance Reimbursement 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Representative GLYNN of South Portland. 
Cosponsored by Representative DUDLEY of Portland. 
Printed on recycled paper 
--;r;~/J1.~ 
MILLICENT M. MacFARLAND 
Clerk 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 24-A MRSA §2744, as amended by PL 2003, c. 65, § 1 and 
affected by §5, is further ~ended to read: 
§Z744. 
Mental health services 
1. 
Notwithstanding any provision of 
a 
health insurance 
policy subject to this chapter, whenever the pOlicy provides for 
payment or reimbursement for services that are within the lawful 
scope of practice of a psychologist licensed to practice in this 
Statef.L a certified social worker licensed for the independent 
practice of social work in this State wae-ha£-~--~-a-mas~eFs 
Qe~Fee-iB-£e€~a~-~~-~~~~~~~~-ee~ea~ieaa±-iB6~i~H~ieBT 
aas-~-~-~a--seeial-w~-r-k-~-<I-r"--at,.-leas~--2-~-6-,--aaG-waeT 
a~~eF-~~-~7--~~S~r-~-be--~~-a£--a-~~~~--seeial 
weFkeF-iB-~ai6-~~a~ef.L a licensed clinical professional counselor 
licensed for the independent practice of counseling wae--has--at 
leas~--~-~&~r&--Qe~tee--~--ee~ase±ia~--~-r~mr-~--aeeFeai~ea 
eQHea~ieBal-~~~~~~~-~&-BeeB-~l~-ia-€~~££€~~£~--~~-at 
leas~--2-~-6--aaGr-a~~eF-~a£~a-rY-~~--~~r-mHs~-~-~~~-a&-a 
eliaieal--p.r-o-t-e-&6-:i:-ona-1--eeHBseleF in this State, 
a marriage and 
family therapist licensed as a marriage and family therapist in 
this State or a licensed nurse who is certified by the American 
Nurses' Association as a clinical specialist in adult psychiatric 
and mental health nursing or as a clinical specialist in child 
and adolescent psychiatric and mental health nursing, 
any person 
covered by the policy is entitled to reimbursement for these 
services if the 
services 
are 
performed 
by 
a 
physicianfL 
a 
psychologist licensed to practice in this StatefL a certified 
social worker licensed for the independent practice of social 
work 
wae--has--a~-~~--a-ma£~~~-~~-~£-~ba~-wetk-~~~-aB 
aeeFeQi~eQ-~~ea~~aa±--~~~t,.~r-~--has--~€£--empleyeQ--iB 
seeial-wetk-~et-~~~~~-6-r~~r-a~~r-Jaa~aFY-±r-19gaT 
HlHs1o--ee licensed as a clinical social worker in this StatefL a 
licensed 
clinical 
professional 
counselor 
licensed 
for 
the 
independent practice of counseling 
wBe--ha&-a~--],ea.&t,.-~-maS1;eFS 
Qe~Fee-~~~~~-~Fem-aB-~~~~~t,.~~~-iB6titHEieBT 
aas-~eB-~~-ia-eeHBseliB~-~~-~-±eas~-~-~-6--aaGr-a~~eF 
JaBHaFY--~r-~~~--mHs~-~-~~~~-as--a-~~~~~~--pFe~essieHal 
eeHBseleF 
in this 
State.,., 
a 
marriage 
and 
family 
therapist 
licensed as a marriage and family therapist in this State or a 
licensed nurse certified by the American Nurses' Association as a 
clinical specialist in adult or child and adolescent psychiatric 
and mental health nursing. 
Payment or reimbursement for services 
rendered by clinical social workers 
licensed in this State, 
licensed clinical professional counselors licensed in this State,_ 
licensed marriage and family therapists licensed in this State CH 
licensed nurses certified by the American Nurses' Asso,_:iatioll 
c1c~ 
clinical specialists in adult or child and adolescent rsvchiatric 
Page l-LR0268(1) 
and mental health nursing may not be conditioned upon prior 
diagnosis 
or 
referral 
by 
a 
physician or 
other 
health care 
professional, except in cases where diagnosis of the condition 
for which the services are rendered is beyond the scope of their 
licensure. 
2. 
Nothing in subsection 1 may be construed to require a 
health insurance policy sUbject to this chapter to provide for 
reimbursement of services that are within the lawful scope of 
practice of a psychologist licensed to practice in this State, a 
clinical 
social 
worker 
licensed 
in 
this 
State, 
a 
clinical 
professional counselor licensed to practice in this State, 
~ 
licensed marriage and family therapist licensed in this State, a 
certified social worker licensed to practice in this StateT or a 
certified nurse licensed to practice in this State. 
3. 
Mental 
health 
services 
provided 
by 
counseling 
professionals. 
Except as provided in subsection 1 with regard to 
reimbursement of clinical professional counselors and marriage 
and family therapists licensed in this State, an insurer that 
issues individual health care contracts providing coverage for 
mental health services shall offer coverage for those services 
when performed by a counseling professional who is licensed by 
the State pursuant to Title 32, chapter 119 to assess and treat 
interpersonal and intrapersonal problems, has at least a masters 
degree 
in counseling or 
a 
related field 
from 
an 
accredited 
educational institution and has been employed as a counselor for 
at least 
years. 
Any 
contract providing 
coverage 
for 
the 
services of counseling professionals pursuant to this section may 
be 
subject 
to 
any 
reasonable 
limitations, 
maximum 
benefits, 
coinsurance, 
deductibles or exclusion provisions applicable to 
overall benefits under the contract. This subsection applies to 
all contracts executed, delivered, issued for delivery, continued 
or renewed in this State on or after January 1, 
1997. 
For 
purposes of this subsection, all contracts are deemed renewed no 
later than the next yearly anniversary of the contract date. 
Sec. 2. 24·A MRSA §2835, as amended by PL 2003, c. 517, Pt. 
H, §13, is further amended to read: 
§2835. 
Mental health services 
1. 
Notwithstanding 
any provision of 
a 
health insurance 
policy or certificate issued under a group policy subject to this 
chapter, 
whenever 
the 
policy 
provides 
for 
payment 
or 
reimbursement for services that are within the lawful scope of 
practice of a psychologist licensed to practice in this StateTL a 
certified social worker licensed for the independent practice of 
social work in this State wae-R-a-6--a.t,...-l-e-as-1:.-a--A'Ia&t-{H"-6---Ge.<H= .. se.---in 
6eeia~-we£k-~~~~~-aeeFeQite~-€e~~a~J~~a~-~~~~~~~h--&a&-geen 
e~pleyea--~-6eeial-~~-fe~--&~-J~~--~-~~--aBa-~--af~eF 
JaB~aFY-~7-~~-~~-lieeB&ea-a6-~-~~~~-~~~-~~~~-iR 
~hi&-S~a~e~L a licensed clin{cal professional counselor licensed 
for the independent practice of counseling 
whe--has--a~-...J.-e-as-t--a 
~a6~eF6--ae~Fee--iR--ee~R6eliR~--fFeffi--aR--aeeFeai~ea--eayea~ieRal 
iB6~i~~~ieBT-ha6-&ee£-~~~~~~1~~~~-~~-l&a&~-~-yeaFs 
aRaT--a~~~-~~-~~--~QQ~7--ffiYS~--9&--~~-~-~--eliRieal 
pFefe66ieRa~--eeYRseleF in this StateTI 
a marriage and family 
therapist licensed as a marriage and family therapist in this 
State or 
a 
licensed nurse who 
is certified by the American 
Nurses' Association as a clinical specialist in adult psychiatric 
and mental health nursing or as a clinical specialist in child 
and adolescent psychiatric and mental health nursing, any person 
covered by the policy is entitled to reimbursement for these 
services if the 
services 
are 
performed 
by 
a 
physicianTL 
a 
psychologist licensed to practice in this 
State~L a certified 
social worker licensed for independent practice in this State whe 
has-~~-~-&-ffia6~eF6-~~-~-&eeial-we~k-~~~-&&-aeeFeai~eQ 
eQ~ea~ieBal-iR6~i~~~ieR7-wh~~~~~-~-~ial-weF~-feF 
a~--l&a&~-~-~~--~£~--wReT--af~eF-~~--~,-~~--m~6~--ge 
lieeBsee-~6-~-&1~&~1-6eeial-w~~ke~--~-~~&-S~a~eTL a licensed 
clinical professional 
counselor 
licensed 
for 
the 
independent 
practice of counseling 
WRe-~&-~-~ea6~--a-~~4T-~~~-iR 
eeYR6eliR~-~~~-aB-~~~~~~~~l-iR6~i~~~ieR7--has--geeR 
effipleyea-iR-~e~£6eJi£~-f~-~...J.~-~~F&-&aGr-af~eF-JaRyaFy-1T 
~gg~T-~-ge-...J.~~-a6-~-eliBieal-~~~~-eeYRseleF in 
this 
State~, 
a 
marriage 
and 
family therapist licensed as 
a 
marriage and family therapist in this State or a licensed nurse 
certified by the 
American Nurses' 
Association as 
a 
clinical 
specialist in adult or child and adolescent psychiatric 
and 
mental health nursing. 
Payment or reimbursement for services 
rendered by clinical social workers 
licensed in this State, 
licensed clinical professional counselors licensed in this State L 
licensed marriage and family therapists licensed in this State or 
licensed nurses certified by the American Nurses' Association as 
clinical specialists in adult or child and adolescent psychiatric 
and mental health nursing may 
not be conditioned upon prior 
diagnosis 
or 
referral 
by 
a 
physician or 
other health care 
professional, except in cases where diagnosis of the condition 
for which the services are rendered is beyond the scope of their 
licensure. 
2. 
Nothing in subsection 1 may be construed to require a 
health insurance policy subject to this chapter to provide for 
reimbursement of services that are wi thin the lawful scope of 
practice of a psychologist licensed to practice in this State, a 
clinical 
social 
worker 
licensed 
ln 
this 
State, 
a 
clinical 
professional 
counselor 
licensed 
in 
this 
State, 
a 
licensed 
marriage and family theraliist licensed in this State l 
2' l_'ertified 
social worker licensed to practice in this StateT or a nurse 
certified and licensed to practice in this State. 
3. 
Mental 
health 
services 
provided 
by 
counseling 
professionals. 
Except as provided in subsection 1 with regard to 
reimbursement of clinical professional counselors and marriage 
and family therapists licensed in this State, an insurer that 
issues group health care contracts providing coverage for mental 
health services shall make available coverage for those services 
when performed by a counseling professional who is licensed by 
the State pursuant to Title 32, chapter 119 to assess and treat 
interpersonal and intrapersonal problems, has at least a masters 
degree 
in counseling or 
a 
related field 
from 
an accredited 
educational institution and has been employed as a counselor for 
at least 
years. 
Any 
contract providing coverage for 
the 
services of counseling professionals pursuant to this section may 
be 
subject 
to 
any 
reasonable 
limitations, 
maximum 
benefits, 
coinsurance, deductibles or exclusion provisions applicable to 
overall benefits under the contract. 
This subsection applies to 
all policies, 
contracts 
and certificates executed, 
delivered, 
issued for delivery, continued or renewed in this State. 
For 
purposes of this subsection, all contracts are deemed renewed no 
later than the next yearly anniversary of the contract date. 
Sec. 3. Application. 
The requirements of this Act apply to 
all policies, 
contracts 
and certificates executed, 
delivered, 
issued for delivery, continued or renewed in this State on or 
after January 1, 2006. 
For purposes of this Act, all contracts 
are 
deemed 
to 
be 
renewed 
no 
later 
than 
the 
next 
yearly 
anniversary of the contract date. 
SUMMARY 
This bill requires that all health care plans reimburse for 
mental health services provided by licensed marriage and family 
therapists. 
The bill applies to all policies issued or renewed 
on or after January 1, 2006.