Maine § 24-A §2835 Mental health services

Maine Statutes

§ 24-A §2835 — Mental health services

Maine·Title 24-A MAINE INSURANCE CODE·Ch. 35 GROUP AND BLANKET HEALTH INSURANCE

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 professional listed in subsection 2‑A, any person covered by the policy is entitled to reimbursement for these services if the services are performed by a physician or a professional listed in subsection 2‑A. Payment or reimbursement for services rendered by a professional listed in subsection 2‑A, paragraph B, C, D, E or F may not be conditioned upon prior diagnosis or referral by a physician or other health care professional, except when diagnosis of the condition for which the services are rendered is beyond the scope of their licensure. 2.

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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 professional listed in subsection 2‑A, any person covered by the policy is entitled to reimbursement for these services if the services are performed by a physician or a professional listed in subsection 2‑A. Payment or reimbursement for services rendered by a professional listed in subsection 2‑A, paragraph B, C, D, E or F may not be conditioned upon prior diagnosis or referral by a physician or other health care professional, except when 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 professional listed in subsection 2‑A.
2-A.

Subsections 1 and 2 apply with respect to the following types of professionals:
3.
Mental health services provided by counseling professionals.
Except as provided in subsection 1 with regard to reimbursement of clinical professional counselors, pastoral 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 master's degree in counseling or a related field from an accredited educational institution and has been employed as a counselor for at least 2 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.

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Legislative History

PL 1975, c. 770, §108 (NEW). PL 1979, c. 541, §A165 (AMD). PL 1983, c. 546, §3 (AMD). PL 1983, c. 805, §3 (AMD). PL 1987, c. 80, §3 (AMD). PL 1995, c. 561, §3 (AMD). PL 2003, c. 65, §2 (AMD). PL 2003, c. 65, §5 (AFF). PL 2003, c. 517, §B13 (AMD). PL 2005, c. 121, §§I3-5 (AMD). PL 2005, c. 213, §2 (AMD). PL 2005, c. 213, §3 (AFF). PL 2005, c. 214, §2 (AMD). PL 2005, c. 214, §3 (AFF). PL 2005, c. 683, §A40 (RPR).