Maine § 24-A §4234-A Mental health services coverage

Maine Statutes

§ 24-A §4234-A — Mental health services coverage

Maine·Title 24-A MAINE INSURANCE CODE·Ch. 56 HEALTH MAINTENANCE ORGANIZATIONS

1.Findings. The Legislature finds that:

2.Policy and purpose. The Legislature declares that it is the policy of this State to:

3.Definitions. For purposes of this section, unless the context otherwise indicates, the following terms have the following meanings.

4.Requirement. Every health maintenance organization that issues individual or group health care contracts providing coverage 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 individual or group contract must provide for medically necessary health care for a person suffering from mental illness. Medically necessary health care includes, but is not limited to, the following serv

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1.
Findings.
The Legislature finds that:
2.
Policy and purpose.
The Legislature declares that it is the policy of this State to:
3.
Definitions.
For purposes of this section, unless the context otherwise indicates, the following terms have the following meanings.
4.
Requirement.
Every health maintenance organization that issues individual or group health care contracts providing coverage 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 individual or group contract must provide for medically necessary health care for a person suffering from mental illness. Medically necessary health care includes, but is not limited to, the following services for a person suffering from a mental illness:
6.
Coverage for treatment of certain mental illnesses.
Coverage for medical treatment for mental illnesses listed in paragraph A‑1 is subject to this subsection.
7.
Mandated offer of coverage for certain mental illnesses.
8.
Contracts; providers.
A health maintenance organization incorporated under this chapter shall allow providers, pursuant to sections 2744 and 2835, to contract for and receive payment, subject to the health maintenance organization's credentialling policy, for the provision of mental health services within the scope of the provider's licensure.
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 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 master's degree in counseling or a related field from an accredited educational institution and has been employed as counselor for at least 2 years. 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.
9.
Limits; coinsurance; deductibles.
A policy or contract that provides coverage for the services required by this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the extent that these provisions are not inconsistent with the requirements of this section.
10.
Reports to the superintendent.
Every health maintenance organization subject to this section shall report its experience for each calendar year to the superintendent no later than April 30th of the following year. The report must be in a form prescribed by the superintendent and include the amount of claims paid in this State for the services required by this section and the total amount of claims paid in this State for individual and group health care contracts, both separated according to those paid for inpatient, day treatment and outpatient services. The superintendent shall compile this data for all health maintenance organizations in an annual report.
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. 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.

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Legislative History

PL 1995, c. 407, §10 (NEW). PL 1995, c. 560, §K82 (AMD). PL 1995, c. 560, §K83 (AFF). PL 1995, c. 637, §§6,7 (AMD). PL 1995, c. 673, §D8 (AMD). PL 1997, c. 174, §1 (AMD). PL 1999, c. 256, §O3 (AMD). PL 2001, c. 354, §3 (AMD). PL 2003, c. 20, §§VV16-24 (AMD). PL 2003, c. 20, §VV25 (AFF). PL 2003, c. 65, §3 (AMD). PL 2003, c. 65, §5 (AFF). PL 2003, c. 689, §B6 (REV). PL 2017, c. 407, Pt. A, §98 (AMD). PL 2019, c. 5, Pt. D, §§3, 4 (AMD). PL 2021, c. 595, §§7, 8 (AMD).