H.B. 1197

VETOES

(e) For the purposes of this section, "drug abuse" has the meaning stated in §
8-101 of the Health - General Article.]

490V.

(A)     (1) IN THIS SECTION THE FOLLOWING TERMS HAVE THE MEANINGS
INDICATED.

(2)      "ALCOHOL ABUSE" HAS THE MEANING STATED IN § 8-101 OF THE
HEALTH - GENERAL ARTICLE.

(3)      "DRUG ABUSE" HAS THE MEANING STATED IN § 8-101 OF THE
HEALTH - GENERAL ARTICLE.

(4)      "MANAGED CARE SYSTEM" MEANS A METHOD THAT A CARRIER
USES TO REVIEW AND PREAUTHORIZE A TREATMENT PLAN THAT A HEALTH CARE
PRACTITIONER DEVELOPS FOR A COVERED PERSON USING A VARIETY OF COST
CONTAINMENT METHODS TO CONTROL UTILIZATION, QUALITY, AND CLAIMS.

(5)      "PARTIAL HOSPITALIZATION" MEANS THE PROVISION OF
MEDICALLY DIRECTED INTENSIVE OR INTERMEDIATE SHORT-TERM TREATMENT
FOR MENTAL ILLNESS, EMOTIONAL DISORDERS, DRUG ABUSE OR ALCOHOL ABUSE
FOR A PERIOD OF LESS THAN 24 HOURS BUT MORE THAN 4 HOURS IN A DAY FOR AN
INSURED, SUBSCRIBER OR MEMBER IN A LICENSED OR CERTIFIED. FACILITY OR
PROGRAM. .

(B)      (1) SUBJECT TO THE PROVISIONS OF THIS SECTION, EACH CONTRACT
OR POLICY OF HEALTH INSURANCE DELIVERED OR ISSUED FOR DELIVERY WITHIN
THIS STATE TO AN EMPLOYER OR AN INDIVIDUAL ON A GROUP OR INDIVIDUAL
BASIS THAT PROVIDES COVERAGE FOR HEALTH CARE ON AN EXPENSE-INCURRED
BASIS MAY NOT DISCRIMINATE AGAINST ANY PERSON WITH A MENTAL ILLNESS,
EMOTIONAL DISORDER OR A DRUG ABUSE OR ALCOHOL ABUSE DISORDER BY
FAILING TO PROVIDE BENEFITS FOR TREATMENT AND DIAGNOSIS OF THESE
ILLNESSES UNDER THE SAME TERMS AND CONDITIONS THAT APPLY UNDER THE
CONTRACT OR POLICY FOR TREATMENT OF PHYSICAL ILLNESS.

(2) IT SHALL NOT BE CONSIDERED TO BE DISCRIMINATORY UNDER
SUBSECTION (B)(1) OF THIS SECTION IF AT LEAST THE FOLLOWING BENEFITS ARE
PROVIDED:

(I) WITH RESPECT TO INPATIENT BENEFITS PROVIDED IN A
LICENSED OR CERTIFIED FACILITY, WHICH SHALL INCLUDE HOSPITAL INPATIENT
BENEFITS, THE TOTAL NUMBER OF DAYS FOR WHICH BENEFITS ARE PAYABLE
SHALL BE:

1. EXCEPT AS PROVIDED IN SUBSECTION (D), FROM JULY 1,
1994 THROUGH JUNE 30, 1995, AT LEAST 60 DAYS IN ANY CALENDAR YEAR OR A
BENEFIT PERIOD OF NOT MORE THAN 12 MONTHS UNDER THE SAME TERMS AND
CONDITIONS THAT APPLY TO BENEFITS AVAILABLE UNDER THE CONTRACT OR
POLICY FOR PHYSICAL ILLNESS; AND

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