Text: S05231 Text: S05233 Text: S05200 - S05299 Text: S Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Amend Senate File 2429 as follows: 1 2 #1. Page 18, by inserting after line 6 the 1 3 following: 1 4 "Sec. . NEW SECTION. 514C.19 MENTAL HEALTH 1 5 AND SUBSTANCE ABUSE COVERAGE. 1 6 1. Notwithstanding the uniformity of treatment 1 7 requirements of section 514C.6, a group policy or 1 8 contract providing for third-party payment or 1 9 prepayment of health or medical expenses shall provide 1 10 mental health and substance abuse treatment coverage 1 11 benefits and shall not impose limitations on financial 1 12 terms for coverage of services for serious mental 1 13 illnesses or substance abuse if similar limitations 1 14 are not imposed on the coverage benefits for services 1 15 for medical or surgical conditions. 1 16 2. For purposes of this section, unless the 1 17 context otherwise requires: 1 18 a. "Serious mental illness" means the following 1 19 disorders, as defined by the American psychiatric 1 20 association's diagnostic and statistical manual of 1 21 mental disorders: 1 22 (1) Schizophrenia. 1 23 (2) Schizo-affective disorder. 1 24 (3) Bipolar disorder. 1 25 (4) Major depressive disorder. 1 26 (5) Obsessive-compulsive disorder. 1 27 (6) Autism. 1 28 (7) Pervasive developmental disorders. 1 29 (8) Panic disorder. 1 30 (9) Paranoia and other psychotic disorders. 1 31 (10) Eating disorders, including but not limited 1 32 to bulimia nervosa and anorexia nervosa. 1 33 b. "Substance abuse" means a pattern of 1 34 pathological use of alcohol or a drug that causes 1 35 impairment in social or occupational functioning, or 1 36 that produces physiological dependency evidenced by 1 37 physical tolerance or by physical symptoms when the 1 38 alcohol or drug is withdrawn. 1 39 2. This section shall not apply to accident-only, 1 40 specific disease, short-term hospital or medical, 1 41 hospital confinement indemnity, credit, dental, 1 42 vision, Medicare supplement, long-term care, basic 1 43 hospital and medical-surgical expense coverage as 1 44 defined by the commissioner, disability income 1 45 insurance coverage, coverage issued as a supplement to 1 46 liability insurance, workers' compensation or similar 1 47 insurance, automobile medical payment insurance, or 1 48 individual accident or sickness policies issued 1 49 pursuant to chapter 513C. 1 50 3. A third-party payor may manage the benefits 2 1 provided through common methods including, but not 2 2 limited to, providing payment of benefits or providing 2 3 care and treatment under a capitated payment system, 2 4 prospective reimbursement rate system, utilization 2 5 control system, incentive system for the use of least 2 6 restrictive and least costly levels of care, a 2 7 preferred provider contract limiting choice of 2 8 specific provider, or any other system, method, or 2 9 organization designed to ensure services are medically 2 10 necessary and clinically appropriate. 2 11 4. A group policy or contract covered under this 2 12 section, at a minimum, shall provide for thirty 2 13 inpatient and sixty outpatient days annually. The 2 14 policy or contract may also include deductibles, 2 15 coinsurance, or copayments if such deductibles, 2 16 coinsurance, or copayments are applicable to other 2 17 medical or surgical services coverage under the policy 2 18 or contract. It is not a violation of this section if 2 19 the policy or contract excludes entirely from coverage 2 20 benefits the cost of providing the following: 2 21 a. Marital, family, educational, developmental, or 2 22 training services. 2 23 b. Care that is substantially custodial in nature. 2 24 c. Services and supplies that are not medically 2 25 necessary or clinically appropriate. 2 26 d. Experimental treatments. 2 27 5. The commissioner, by rule, shall increase the 2 28 mental health and substance abuse lifetime limit in 2 29 the individual market guaranteed standard product to 2 30 one hundred thousand dollars. 2 31 6. A group policy is exempt from this section upon 2 32 submitting to the commissioner evidence demonstrating 2 33 a premium increase for the policy term in excess of 2 34 three percent as a result of the requirements of this 2 35 section. 2 36 7. This section applies to third-party payment 2 37 provider contracts or policies delivered, issued for 2 38 delivery, continued, or renewed in this state on or 2 39 after January 1, 2001. 2 40 8. This section is repealed effective July 1, 2 41 2003." 2 42 #2. By renumbering as necessary. 2 43 2 44 2 45 2 46 PATRICK J. DELUHERY 2 47 MICHAEL E. GRONSTAL 2 48 DENNIS H. BLACK 2 49 ROBERT E. DVORSKY 2 50 TOM FLYNN 3 1 MARK SHEARER 3 2 JOHN JUDGE 3 3 MIKE CONNOLLY 3 4 JOHNIE HAMMOND 3 5 JOHN P. KIBBIE 3 6 DICK L. DEARDEN 3 7 WALLY E. HORN 3 8 JOE BOLKCOM 3 9 PATRICIA HARPER 3 10 BETTY A. SOUKUP 3 11 ELAINE SZYMONIAK 3 12 EUGENE S. FRAISE 3 13 SF 2429.701 78 3 14 rn/cls
Text: S05231 Text: S05233 Text: S05200 - S05299 Text: S Index Bills and Amendments: General Index Bill History: General Index
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