Text: HF00240 Text: HF00242 Text: HF00200 - HF00299 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 health care provider licensed under 1 19 Title IV, subtitle 3, if the services are provided within the 1 20 scope of practice of such health care provider and within 1 21 approved case management guidelines applicable to such mental 1 22 illness. Coverage shall include prescription drugs. 1 23 (2) For the treatment of alcohol or substance abuse, 1 24 coverage shall be for services provided by a substance abuse 1 25 counselor, as approved by the department of human services, a 1 26 licensed health facility providing a program for the treatment 1 27 of alcohol or substance abuse approved by the department of 1 28 human services, or a licensed substance abuse treatment and 1 29 rehabilitation facility. 1 30 2. This section applies to the following classes of third- 1 31 party payment provider contracts or policies delivered, issued 1 32 for delivery, continued, or renewed in this state on or after 1 33 January 1, 2000: 1 34 a. Individual or group accident and sickness insurance 1 35 providing coverage on an expense-incurred basis. 2 1 b. An individual or group hospital or medical service 2 2 contract issued pursuant to chapter 509, 514, or 514A. 2 3 c. An individual or group health maintenance organization 2 4 contract regulated under chapter 514B. 2 5 d. An individual or group Medicare supplemental policy, 2 6 unless coverage pursuant to such policy is preempted by 2 7 federal law. 2 8 e. Any other entity engaged in the business of insurance, 2 9 risk transfer, or risk retention, which is subject to the 2 10 jurisdiction of the commissioner. 2 11 f. An organized delivery system licensed by the director 2 12 of public health. 2 13 3. For purposes of this section, unless the context 2 14 otherwise requires: 2 15 a. "Mental health condition" means a condition or disorder 2 16 involving mental illness or alcohol or substance abuse that 2 17 falls under any of the diagnostic categories listed in the 2 18 mental disorders section of the international classification 2 19 of disease, as periodically revised. 2 20 b. "Rates, terms, and conditions" means any lifetime 2 21 payment limits, deductibles, copayments, coinsurance, and any 2 22 other cost-sharing requirements, out-of-pocket limits, visit 2 23 limitations, and any other financial component of benefits 2 24 coverage that affects the covered individual. 2 25 Sec. 2. INSURANCE DIVISION STUDY. 2 26 1. The insurance division of the department of commerce 2 27 shall conduct a study to determine the impact of providing the 2 28 coverage required in this Act. The division shall include in 2 29 the study all of the following: 2 30 a. An estimate of the impact of the mandated coverage on 2 31 health care coverage benefit costs. 2 32 b. Actions taken by the division to assure that third- 2 33 party payors subject to this Act are in compliance, and that 2 34 the quality of and access to treatment for mental health 2 35 conditions, as defined in section 514C.14, are not compromised 3 1 by providing for coverage parity with other coverage benefits 3 2 provided for other health or medical conditions under third- 3 3 party payor contracts or policies. 3 4 c. An analysis and comparison of the choices for treatment 3 5 of mental health conditions provided with regard to level of 3 6 access, choice, and financial burden on the individual. 3 7 d. Identification of any segments of the population of 3 8 this state that may be excluded from, or have limited access 3 9 to, treatment for mental health conditions, including the 3 10 number of citizens that may be excluded from, or have limited 3 11 access to, treatment under third-party payor policies or 3 12 contracts provided by employers who receive substantial 3 13 revenue from public sources. 3 14 2. The insurance division shall submit a written report to 3 15 the general assembly on or before January 15, 2002. 3 16 EXPLANATION 3 17 This bill creates new Code section 514C.14 and provides 3 18 that a policy or contract providing for third-party payment or 3 19 prepayment of health or medical expenses must provide coverage 3 20 benefits for mental health conditions based on rates, terms, 3 21 and conditions which are no more restrictive than the rates, 3 22 terms, and conditions associated with coverage benefits 3 23 provided for other conditions under the policy or contract. 3 24 Mental health conditions are defined to mean a condition or 3 25 disorder involving mental illness or alcohol or substance 3 26 abuse that falls under any of the diagnostic categories listed 3 27 in the mental disorders section of the international 3 28 classification of disease, as periodically updated. 3 29 The bill also provides that the insurance division of the 3 30 department of commerce is to conduct a study to determine the 3 31 impact of providing such coverage including an estimate of the 3 32 impact of the mandated coverage on health care coverage 3 33 benefit costs; actions taken by the division to assure that 3 34 third-party payors subject to the bill are in compliance, and 3 35 that the quality of and access to treatment for mental health 4 1 conditions are not compromised by providing for coverage 4 2 parity with other coverage benefits provided for other health 4 3 or medical conditions under third-party payor contracts or 4 4 policies; an analysis and comparison of the choices for 4 5 treatment of mental health conditions provided with regard to 4 6 level of access, choice, and financial burden on the 4 7 individual; and identification of any segments of the 4 8 population of this state that may be excluded from, or have 4 9 limited access to, treatment for mental health conditions, 4 10 including the number of citizens that may be excluded from, or 4 11 have limited access to, treatment under third-party payor 4 12 policies or contracts provided by employers who receive 4 13 substantial revenue from public sources. The report is to be 4 14 provided to the general assembly on or before January 15, 4 15 2002. 4 16 LSB 1490HH 78 4 17 mj/cf/24.1
Text: HF00240 Text: HF00242 Text: HF00200 - HF00299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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