S.F. 2204 Section 1. NEW SECTION . 514C.31 Eating disorders —— 1 coverage. 2 1. Notwithstanding the uniformity of treatment requirements 3 of section 514C.6, a policy, contract, or plan providing for 4 third-party payment or prepayment of health or medical expenses 5 shall provide coverage benefits for the diagnostic assessment 6 and treatment of eating disorders. 7 2. As used in this section, unless the context otherwise 8 requires: 9 a. “Diagnostic assessment of eating disorders” means 10 medically necessary assessments, evaluations, or tests 11 performed by a physician or psychiatrist licensed pursuant to 12 chapter 148, a psychologist licensed pursuant to chapter 154B, 13 an advanced registered nurse practitioner licensed pursuant to 14 chapter 152 or 152E, a dietician licensed pursuant to chapter 15 152A, a social worker licensed pursuant to chapter 154C, or 16 a mental health counselor or marital and family therapist 17 licensed pursuant to chapter 154D, to diagnose whether an 18 individual has an eating disorder. 19 b. “Eating disorders” means pica, rumination disorder, 20 avoidant or restrictive food intake disorder, anorexia nervosa, 21 bulimia nervosa, binge eating disorder, other specified feeding 22 or eating disorder, or any other eating disorder not otherwise 23 specified. The commissioner, by rule, shall define “eating 24 disorders” consistent with definitions provided in the most 25 recent edition of the American psychiatric association’s 26 diagnostic and statistical manual of mental disorders, as such 27 definitions may be amended from time to time. The commissioner 28 may adopt the definitions provided in such manual by reference. 29 c. “Pharmacy care” means medications prescribed by 30 a licensed physician or psychiatrist and includes any 31 health-related services deemed medically necessary to determine 32 the need for or effectiveness of the medications prescribed, 33 but only to the extent that coverage of such medications is 34 included in the insured’s health coverage benefits. 35 -1- SF 2204 (2) 86 av/rj/jh 1/ 4

S.F. 2204 d. “Psychiatric care” or “psychological care” means 1 direct or consultative services provided during inpatient 2 hospitalization, partial hospitalization, residential 3 care, intensive outpatient treatment, follow-up outpatient 4 care, or counseling, provided by a licensed psychiatrist or 5 psychologist. 6 e. “Therapeutic care” means medical care or behavioral 7 interventions provided by a licensed physician, psychiatrist, 8 psychologist, advanced registered nurse practitioner, 9 dietician, social worker, mental health counselor, or marital 10 and family therapist. 11 f. “Treatment of eating disorders” means treatment that 12 is identified in a treatment plan and includes medically 13 necessary pharmacy care, psychiatric or psychological 14 care, or therapeutic care, that is provided by a licensed 15 physician, psychiatrist, psychologist, advanced registered 16 nurse practitioner, dietician, social worker, mental health 17 counselor, or marital and family therapist. 18 g. “Treatment plan” means a plan for the treatment of eating 19 disorders developed by a licensed physician, psychiatrist, 20 psychologist, advanced registered nurse practitioner, 21 dietician, social worker, mental health counselor, or marital 22 and family therapist that includes all of the following: 23 (1) A diagnosis. 24 (2) Proposed treatment by type, frequency, and duration of 25 treatment. 26 (3) Goals. 27 (4) All elements necessary for the third-party payment or 28 prepayment of claims. 29 3. Coverage required by this section is limited to medically 30 necessary diagnostic assessment and treatment of eating 31 disorders in accordance with a treatment plan, that is provided 32 by a licensed physician, psychiatrist, psychologist, advanced 33 registered nurse practitioner, dietician, social worker, mental 34 health counselor, or marital and family therapist acting 35 -2- SF 2204 (2) 86 av/rj/jh 2/ 4

S.F. 2204 pursuant to that person’s applicable scope of practice. 1 4. Coverage required pursuant to this section shall be 2 subject to copayment, deductible, and coinsurance provisions, 3 and any other general exclusions or limitations of a policy, 4 contract, or plan to the same extent as other health or medical 5 services covered by the policy, contract, or plan. 6 5. This section shall not be construed to limit benefits 7 which are otherwise available to an individual under a policy, 8 contract, or plan. 9 6. a. Coverage of the diagnosis and treatment of eating 10 disorders may be subject to other general exclusions and 11 limitations of the policy, contract, or plan providing for 12 third-party payment or prepayment of health or medical expenses 13 not in conflict with the provisions of this section, such 14 as coordination of benefits, and utilization of health care 15 services, which include reviews of medical necessity and care 16 management. 17 b. Medical necessity determinations and care management 18 for the treatment of eating disorders shall do all of the 19 following: 20 (1) Consider the overall medical and mental health needs of 21 the individual diagnosed with an eating disorder. 22 (2) Not be based solely on the weight of the individual 23 diagnosed with an eating disorder. 24 (3) Take into consideration the most recent practice 25 guideline for the treatment of patients with eating disorders 26 adopted by the American psychiatric association in addition to 27 current standards based upon the medical literature generally 28 recognized as authoritative in the medical community. 29 7. The commissioner shall adopt rules pursuant to chapter 30 17A to implement and administer this section. 31 8. This section shall not apply to accident-only, 32 specified disease, short-term hospital or medical, hospital 33 confinement indemnity, credit, dental, vision, Medicare 34 supplement, long-term care, basic hospital and medical-surgical 35 -3- SF 2204 (2) 86 av/rj/jh 3/ 4

S.F. 2204 expense coverage as defined by the commissioner, disability 1 income insurance coverage, coverage issued as a supplement 2 to liability insurance, workers’ compensation or similar 3 insurance, or automobile medical payment insurance, or 4 individual accident and sickness policies issued to individuals 5 or to individual members of a member association. 6 9. This section applies to the following classes of 7 third-party payment provider policies, contracts, or plans 8 delivered, issued for delivery, continued, or renewed in this 9 state on or after January 1, 2017: 10 a. Individual or group accident and sickness insurance 11 providing coverage on an expense-incurred basis. 12 b. An individual or group hospital or medical service 13 contract issued pursuant to chapter 509, 514, or 514A. 14 c. An individual or group health maintenance organization 15 contract regulated under chapter 514B. 16 d. Any other entity engaged in the business of insurance, 17 risk transfer, or risk retention, which is subject to the 18 jurisdiction of the commissioner. 19 e. A plan established pursuant to chapter 509A for public 20 employees. 21 f. An organized delivery system licensed by the director of 22 public health. 23 -4- SF 2204 (2) 86 av/rj/jh 4/ 4