Text: HF02079 Text: HF02081 Text: HF02000 - HF02099 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. NEW SECTION. 514C.19 BIOLOGICALLY BASED 1 2 MENTAL ILLNESS. 1 3 1. Notwithstanding the uniformity of treatment 1 4 requirements of section 514C.6, a group policy or contract 1 5 providing for third-party payment or prepayment of health or 1 6 medical expenses issued by a carrier, as defined in section 1 7 513B.2, or by an organized delivery system authorized under 1 8 1993 Iowa Acts, chapter 158, shall provide coverage benefits 1 9 for treatment of a biologically based mental illness if either 1 10 of the following is satisfied: 1 11 a. The policy or contract is issued to an employer who on 1 12 at least fifty percent of the employer's working days during 1 13 the preceding calendar year employed more than fifty full-time 1 14 equivalent employees. In determining the number of full-time 1 15 equivalent employees of an employer, employers who are 1 16 affiliated or who are able to file a consolidated tax return 1 17 for purposes of state taxation shall be considered one 1 18 employer. 1 19 b. The policy or contract is issued to a small employer as 1 20 defined in section 513B.2, and such policy or contract 1 21 provides coverage benefits for the treatment of mental 1 22 illness. 1 23 2. Notwithstanding the uniformity of treatment 1 24 requirements of section 514C.6, a plan established pursuant to 1 25 chapter 509A for public employees shall provide coverage 1 26 benefits for treatment of a biologically based mental illness. 1 27 3. For purposes of this section, "biologically based 1 28 mental illness" means the following psychiatric illnesses: 1 29 a. Schizophrenia. 1 30 b. Bipolar disorders. 1 31 c. Major depressive disorders. 1 32 d. Schizo-affective disorders. 1 33 e. Obsessive-compulsive disorders. 1 34 f. Pervasive developmental disorders. 1 35 g. Autistic disorders. 2 1 4. The commissioner, by rule, shall define the 2 2 biologically based mental illnesses identified in subsection 2 3 3. Definitions established by the commissioner shall be 2 4 consistent with definitions provided in the most recent 2 5 edition of the American psychiatric association's diagnostic 2 6 and statistical manual of mental disorders, as such 2 7 definitions may be amended from time to time. The 2 8 commissioner may adopt the definitions provided in such manual 2 9 by reference. 2 10 5. This section shall not apply to accident only, 2 11 specified disease, short-term hospital or medical, hospital 2 12 confinement indemnity, credit, dental, vision, Medicare 2 13 supplement, long-term care, basic hospital and medical- 2 14 surgical expense coverage as defined by the commissioner, 2 15 disability income insurance coverage, coverage issued as a 2 16 supplement to liability insurance, workers' compensation or 2 17 similar insurance, or automobile medical payment insurance, or 2 18 individual accident and sickness policies issued to 2 19 individuals or to individual members of a member association. 2 20 6. A carrier, organized delivery system, or plan 2 21 established pursuant to chapter 509A may manage the benefits 2 22 provided through common methods including, but not limited to, 2 23 providing payment of benefits or providing care and treatment 2 24 under a capitated payment system, prospective reimbursement 2 25 rate system, utilization control system, incentive system for 2 26 the use of least restrictive and least costly levels of care, 2 27 a preferred provider contract limiting choice of specific 2 28 providers, or any other system, method, or organization 2 29 designed to assure services are medically necessary and 2 30 clinically appropriate. 2 31 7. a. A group policy or contract or plan covered under 2 32 this section shall not impose an aggregate annual or lifetime 2 33 limit on biologically based mental illness coverage benefits 2 34 unless the policy or contract or plan imposes an aggregate 2 35 annual or lifetime limit on substantially all medical and 3 1 surgical coverage benefits. 3 2 b. A group policy or contract or plan covered under this 3 3 section that imposes an aggregate annual or lifetime limit on 3 4 substantially all medical and surgical coverage benefits shall 3 5 not impose an aggregate annual or lifetime limit on 3 6 biologically based mental illness coverage benefits which is 3 7 less than the aggregate annual or lifetime limit imposed on 3 8 substantially all medical and surgical coverage benefits. 3 9 8. A group policy or contract or plan covered under this 3 10 section shall at a minimum allow for thirty inpatient days and 3 11 fifty-two outpatient visits annually. The policy or contract 3 12 or plan may also include deductibles, coinsurance, or 3 13 copayments, provided the amounts and extent of such 3 14 deductibles, coinsurance, or copayments applicable to other 3 15 medical or surgical services coverage under the policy or 3 16 contract or plan are the same. It is not a violation of this 3 17 section if the policy or contract or plan excludes entirely 3 18 from coverage benefits for the cost of providing the 3 19 following: 3 20 a. Marital, family, educational, developmental, or 3 21 training services. 3 22 b. Care that is substantially custodial in nature. 3 23 c. Services and supplies that are not medically necessary 3 24 or clinically appropriate. 3 25 d. Experimental treatments. 3 26 9. This section applies to third-party payment provider 3 27 policies or contracts and plans established pursuant to 3 28 chapter 509A delivered, issued for delivery, continued, or 3 29 renewed in this state on or after January 1, 2001. 3 30 HF 2080 3 31 mj/jg/25
Text: HF02079 Text: HF02081 Text: HF02000 - HF02099 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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