Text: HF02239 Text: HF02241 Text: HF02200 - HF02299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. NEW SECTION. 514C.14 MANDATED COVERAGE FOR 1 2 MENTAL HEALTH. 1 3 1. a. Notwithstanding section 514C.6, a policy or 1 4 contract providing for third-party payment or prepayment of 1 5 health or medical expenses shall provide coverage benefits for 1 6 mental health conditions based on rates, terms, and conditions 1 7 which are no more restrictive than the rates, terms, and 1 8 conditions for coverage benefits provided for other health or 1 9 medical conditions under the policy or contract. 1 10 Additionally, any rates, terms, and conditions involving 1 11 deductibles, copayments, coinsurance, and any other cost- 1 12 sharing requirements shall be cumulative for coverage of both 1 13 mental health conditions and other health or medical 1 14 conditions under the policy or contract. 1 15 b. Coverage required under this subsection shall be as 1 16 follows: 1 17 (1) For the treatment of mental illness, coverage shall be 1 18 for services provided by a licensed mental health 1 19 professional, or services provided in a licensed hospital or 1 20 health facility. 1 21 (2) For the treatment of alcohol or substance abuse, 1 22 coverage shall be for services provided by a substance abuse 1 23 counselor, as approved by the department of human services, a 1 24 licensed health facility providing a program for the treatment 1 25 of alcohol or substance abuse approved by the department of 1 26 human services, or a licensed substance abuse treatment and 1 27 rehabilitation facility. 1 28 2. This section applies to the following classes of third- 1 29 party payment provider contracts or policies delivered, issued 1 30 for delivery, continued, or renewed in this state on or after 1 31 January 1, 1999: 1 32 a. Individual or group accident and sickness insurance 1 33 providing coverage on an expense-incurred basis. 1 34 b. An individual or group hospital or medical service 1 35 contract issued pursuant to chapter 509, 514, or 514A. 2 1 c. An individual or group health maintenance organization 2 2 contract regulated under chapter 514B. 2 3 d. An individual or group Medicare supplemental policy, 2 4 unless coverage pursuant to such policy is preempted by 2 5 federal law. 2 6 e. Any other entity engaged in the business of insurance, 2 7 risk transfer, or risk retention, which is subject to the 2 8 jurisdiction of the commissioner. 2 9 f. An organized delivery system licensed by the director 2 10 of public health. 2 11 3. For purposes of this section, unless the context 2 12 otherwise requires: 2 13 a. "Mental health condition" means a condition or disorder 2 14 involving mental illness or alcohol or substance abuse that 2 15 falls under any of the diagnostic categories listed in the 2 16 mental disorders section of the international classification 2 17 of disease, as periodically revised. 2 18 b. "Rates, terms, and conditions" means any lifetime 2 19 payment limits, deductibles, copayments, coinsurance, and any 2 20 other cost-sharing requirements, out-of-pocket limits, visit 2 21 limitations, and any other financial component of benefits 2 22 coverage that affects the covered individual. 2 23 Sec. 2. INSURANCE DIVISION STUDY. 2 24 1. The insurance division of the department of commerce 2 25 shall conduct a study to determine the impact of providing the 2 26 coverage required in this Act. The division shall include in 2 27 the study all of the following: 2 28 a. An estimate of the impact of the mandated coverage on 2 29 health care coverage benefit costs. 2 30 b. Actions taken by the division to assure that third- 2 31 party payors subject to this Act are in compliance, and that 2 32 the quality of and access to treatment for mental health 2 33 conditions, as defined in section 514C.14, are not compromised 2 34 by providing for coverage parity with other coverage benefits 2 35 provided for other health or medical conditions under third- 3 1 party payor contracts or policies. 3 2 c. An analysis and comparison of the choices for treatment 3 3 of mental health conditions provided with regard to level of 3 4 access, choice, and financial burden on the individual. 3 5 d. Identification of any segments of the population of 3 6 this state that may be excluded from, or have limited access 3 7 to, treatment for mental health conditions, including the 3 8 number of citizens that may be excluded from, or have limited 3 9 access to, treatment under third-party payor policies or 3 10 contracts provided by employers who receive substantial 3 11 revenue from public sources. 3 12 2. The insurance division shall submit a written report to 3 13 the general assembly on or before January 15, 2001. 3 14 EXPLANATION 3 15 This bill creates new Code section 514C.14 and provides 3 16 that a policy or contract providing for third-party payment or 3 17 prepayment of health or medical expenses must provide coverage 3 18 benefits for mental health conditions based on rates, terms, 3 19 and conditions which are no more restrictive than the rates, 3 20 terms, and conditions associated with coverage benefits 3 21 provided for other conditions under the policy or contract. 3 22 Mental health conditions are defined to mean a condition or 3 23 disorder involving mental illness or alcohol or substance 3 24 abuse that falls under any of the diagnostic categories listed 3 25 in the mental disorders section of the international 3 26 classification of disease, as periodically updated. 3 27 The bill also provides that the insurance division of the 3 28 department of commerce is to conduct a study to determine the 3 29 impact of providing such coverage including an estimate of the 3 30 impact of the mandated coverage on health care coverage 3 31 benefit costs; actions taken by the division to assure that 3 32 third-party payors subject to the bill are in compliance, and 3 33 that the quality of and access to treatment for mental health 3 34 conditions are not compromised by providing for coverage 3 35 parity with other coverage benefits provided for other health 4 1 or medical conditions under third-party payor contracts or 4 2 policies; an analysis and comparison of the choices for 4 3 treatment of mental health conditions provided with regard to 4 4 level of access, choice, and financial burden on the 4 5 individual; and identification of any segments of the 4 6 population of this state that may be excluded from, or have 4 7 limited access to, treatment for mental health conditions, 4 8 including the number of citizens that may be excluded from, or 4 9 have limited access to, treatment under third-party payor 4 10 policies or contracts provided by employers who receive 4 11 substantial revenue from public sources. The report is to be 4 12 provided to the general assembly on or before January 15, 4 13 2001. 4 14 LSB 3543HH 77 4 15 mj/cf/24
Text: HF02239 Text: HF02241 Text: HF02200 - HF02299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
© 1998 Cornell College and League of Women Voters of Iowa
Comments about this site or page?
webmaster@legis.iowa.gov.
Please remember that the person listed above does not vote on bills. Direct all comments concerning legislation to State Legislators.
Last update: Fri Feb 20 03:42:16 CST 1998
URL: /DOCS/GA/77GA/Legislation/HF/02200/HF02240/980212.html
jhf