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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