House File 93 - Introduced HOUSE FILE 93 BY M. SMITH , PETERSEN , ABDUL-SAMAD , HUNTER , LENSING , RUNNING-MARQUARDT , WESSEL-KROESCHELL , MASCHER , OLDSON , HEDDENS , ISENHART , HALL , KEARNS , KELLEY , GASKILL , HANSON , and STECKMAN A BILL FOR An Act relating to third-party payment of health care coverage 1 costs for mental health conditions, including alcohol 2 or substance abuse treatment services, creation of a 3 mental health insurance advisory committee, and including 4 applicability provisions and a repeal. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 TLSB 1149HH (5) 84 av/nh

H.F. 93 Section 1. NEW SECTION . 514C.29 Mandated coverage for 1 mental health conditions —— mental health insurance advisory 2 committee. 3 1. For purposes of this section, unless the context 4 otherwise requires: 5 a. “Mental health condition” means a condition or disorder 6 involving mental illness or alcohol or substance abuse as 7 defined by the commissioner of insurance, by rule, consistent 8 with conditions or disorders that fall under any of the 9 diagnostic categories listed in the mental disorders section of 10 the international classification of diseases, as periodically 11 revised. The commissioner may adopt the lists or definitions 12 provided in such classification of disease by reference. 13 b. “Rates, terms, and conditions” means any lifetime 14 payment limits, deductibles, copayments, coinsurance, and any 15 other cost-sharing requirements, out-of-pocket limits, visit 16 limitations, and any other financial component of benefits 17 coverage that affects the covered individual. 18 2. a. Notwithstanding section 514C.6, a policy, contract, 19 or plan providing for third-party payment or prepayment of 20 health or medical expenses shall provide coverage benefits for 21 mental health conditions based on rates, terms, and conditions 22 which are no more restrictive than the rates, terms, and 23 conditions for coverage benefits provided for other health 24 or medical conditions under the policy, contract, or plan. 25 Additionally, any rates, terms, and conditions involving 26 deductibles, copayments, coinsurance, and any other cost- 27 sharing requirements shall be cumulative for coverage of both 28 mental health conditions and other health or medical conditions 29 under the policy, contract, or plan. 30 b. Coverage required under this subsection shall be as 31 follows: 32 (1) For the treatment of mental illness, coverage shall be 33 for services provided by a licensed mental health professional 34 or services provided in a licensed hospital or health facility. 35 -1- LSB 1149HH (5) 84 av/nh 1/ 4

H.F. 93 (2) For the treatment of alcohol or substance abuse, 1 coverage shall be for services provided by a substance 2 abuse counselor, as approved by the department of human 3 services; a licensed health facility providing a program for 4 the treatment of alcohol or substance abuse approved by the 5 department of human services; or a substance abuse treatment 6 and rehabilitation facility, as licensed by the department of 7 public health pursuant to chapter 125. 8 3. This section applies to the following classes of 9 third-party payment provider contracts, policies, or plans 10 delivered, issued for delivery, continued, or renewed in this 11 state on or after January 1, 2012: 12 a. Individual or group accident and sickness insurance 13 providing coverage on an expense-incurred basis. 14 b. An individual or group hospital or medical service 15 contract issued pursuant to chapter 509, 514, or 514A. 16 c. A plan established pursuant to chapter 509A for public 17 employees. 18 d. An individual or group health maintenance organization 19 contract regulated under chapter 514B. 20 e. An individual or group Medicare supplemental policy, 21 unless coverage pursuant to such policy is preempted by federal 22 law. 23 f. Any other entity engaged in the business of insurance, 24 risk transfer, or risk retention, which is subject to the 25 jurisdiction of the commissioner. 26 g. An organized delivery system licensed by the director of 27 public health. 28 4. The commissioner shall adopt rules to administer this 29 section after consultation with the mental health insurance 30 advisory committee. 31 a. The commissioner shall appoint members to a mental 32 health insurance advisory committee. Members shall include all 33 sectors of society impacted by issues associated with coverage 34 of mental health treatment by third-party payors including 35 -2- LSB 1149HH (5) 84 av/nh 2/ 4

H.F. 93 but not limited to representatives of the insurance industry, 1 small and large employers, employee representatives including 2 labor, individual consumers, health care providers, and other 3 groups and individuals that may be identified by the insurance 4 division of the department of commerce. 5 b. The committee shall meet upon the request of the 6 commissioner to review rules proposed under this section by the 7 commissioner, and to make suggestions as appropriate. 8 Sec. 2. REPEAL. Section 514C.22, Code 2011, is repealed 9 effective January 1, 2012. 10 EXPLANATION 11 This bill creates new Code section 514C.29 and provides that 12 a policy, contract, or plan providing for third-party payment 13 or prepayment of health or medical expenses must provide 14 coverage benefits for mental health conditions based on rates, 15 terms, and conditions which are no more restrictive than the 16 rates, terms, and conditions associated with coverage benefits, 17 provided for other conditions under the policy, contract, or 18 plan. “Mental health conditions” are to be defined, by rule, 19 by the commissioner of insurance consistent with conditions 20 or disorders involving mental illness or alcohol or substance 21 abuse that fall under any of the diagnostic categories 22 listed in the mental disorders section of the international 23 classification of diseases, as periodically updated. 24 The bill also requires the commissioner of insurance 25 to adopt rules to administer the new Code section, after 26 consultation with a new mental health insurance advisory 27 committee, whose members are appointed by the commissioner from 28 business, consumer, and health groups. 29 The bill applies to third-party payment provider contracts, 30 policies, or plans delivered, issued forth for delivery, 31 continued, or renewed in this state on or after January 1, 32 2012. 33 Code section 514C.22, which currently mandates coverage 34 for certain biologically based mental illnesses, is repealed 35 -3- LSB 1149HH (5) 84 av/nh 3/ 4