WILLIAM DONALD SCHAEFER, Governor                        H.B. 1197

(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 A
MEMBER OR SUBSCRIBER IN A LICENSED OR CERTIFIED FACILITY OR PROGRAM.

(B) (1) SUBJECT TO THE PROVISIONS OF THIS SECTION, EACH CONTRACT
OR CERTIFICATE ISSUED TO A MEMBER OR SUBSCRIBER BY A HEALTH
MAINTENANCE ORGANIZATION THAT PROVIDES HEALTH BENEFITS AND SERVICES
FOR DISEASES 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 AS PROVIDED FOR COVERED
BENEFITS OFFERED UNDER THE CONTRACT OR CERTIFICATE FOR THE 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
BENEFIT PERIOD OF NOT MORE THAN 12 MONTHS UNDER THE SAME TERMS AND
CONDITIONS THAT APPLY TO BENEFITS AVAILABLE UNDER THE CONTRACT OR
CERTIFICATE FOR PHYSICAL ILLNESS; AND

2.        ON OR AFTER JULY 1, 1995, AT LEAST EQUAL TO THE SAME
TERMS AND CONDITIONS THAT APPLY TO THE BENEFITS AVAILABLE UNDER THE
CONTRACT OR CERTIFICATE FOR PHYSICAL ILLNESS;

(II)     SUBJECT TO SUBSECTION (F) OF THIS SECTION, WITH RESPECT
TO BENEFITS FOR PARTIAL HOSPITALIZATION, AT LEAST 60 DAYS OF PARTIAL
HOSPITALIZATION SHALL BE COVERED UNDER THE SAME TERMS AND CONDITIONS
THAT APPLY TO THE BENEFIT AVAILABLE UNDER THE CONTRACT OR CERTIFICATE
FOR PHYSICAL ILLNESS; AND

(III)    WITH RESPECT TO OUTPATIENT COVERAGE, OTHER THAN FOR
INPATIENT OR PARTIAL HOSPITALIZATION SERVICES, BENEFITS FOR COVERED
EXPENSES ARISING FROM SERVICES WHICH ARE RENDERED TO TREAT MENTAL
ILLNESS, EMOTIONAL DISORDERS, DRUG ABUSE AND ALCOHOL ABUSE SHALL BE AT
A RATE WHICH IS, AFTER THE APPLICABLE DEDUCTIBLE, NOT LESS THAN:

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