WILLIAM DONALD SCHAEFER, Governor

Ch. 2

(ii) Justification for length of stay shall be documented by a qualified
psychiatrist or psychologist based on a monthly evaluation of the patient which is
available to the insurance company at their request;

(iii) The insurance company, as a condition precedent to the allowance
for benefits for residency in a psychiatric halfway house, may require the certification in
writing by a licensed psychiatrist or psychologist that residency in a psychiatric halfway
house is medically necessary either in lieu of or in combination with confinement as an
inpatient in a hospital and will reduce the length of confinement as an inpatient in a
hospital;

(iv) The total benefits payable for treatment as an inpatient in a
hospital or residency in a psychiatric halfway house or a combination of both may not
exceed the cost of benefits available annually for treatment as an inpatient in a hospital.

(b) The provisions of this section apply to all policies issued, renewed, modified,
altered, amended, or reissued on or after July 1, 1973.]

[477E.

(a) Every hospital or major medical insurance policy or certificate written on an
expense-incurred basis which is delivered, or issued for delivery, within this State must
include benefits for expenses arising from treatment of acute mental illnesses and
emotional disorders which in the professional judgment of practitioners are subject to
significant improvement through short-term therapy. These benefits must be at least
equal to the following minimum requirements:

(1)     With respect to benefits for confinement as an inpatient in a hospital,
the period of confinement for which benefits are payable shall be at least 30 days in any
calendar year or benefit period;

(2)     With respect to major medical expense coverage, benefits, after the
applicable deductible, for covered expenses arising from all those services, other than
inpatient, which are rendered to treat acute mental illness and emotional disorders, shall
be at a rate which is not less than 65 percent for the first 20 visits per calendar year or
benefit period and not less than 50 percent for any visits thereafter for that calendar year
or benefit period, of the benefits which the policy provides for other types of illness; and

(3)     (i) With respect to benefits for residency in a Department of Health
and Mental Hygiene approved psychiatric halfway house, the period of residency for
which benefits are payable shall be at least 120 days and shall be at a rate which is not less
than 75 percent of the per diem rate which amount may not exceed $30 per day;

(ii) Justification for length of stay shall be documented by a qualified
psychiatrist or psychologist based on a monthly evaluation of the patient which is
available to the insurance company at their request;

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