Text: SF00082 Text: SF00084 Text: SF00000 - SF00099 Text: SF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 514C.14 MENTAL HEALTH AND
1 2 SUBSTANCE ABUSE TREATMENT COVERAGE.
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 and substance abuse conditions based on rates,
1 7 terms, and conditions which are no more restrictive than the
1 8 rates, terms, and conditions for coverage benefits provided
1 9 for other health or medical conditions under the policy or
1 10 contract.
1 11 b. Coverage required under this section includes the
1 12 following:
1 13 (1) For the treatment of mental illness, services provided
1 14 by a licensed mental health professional, or services provided
1 15 in a licensed hospital or health facility.
1 16 (2) For the treatment of substance abuse or other
1 17 addictive disorder, services provided by a qualified
1 18 professional as defined by rule of the Iowa department of
1 19 public health, a licensed health facility providing a program
1 20 for the treatment of substance abuse or other addictive
1 21 disorder approved by the Iowa department of public health, or
1 22 a licensed substance abuse treatment and rehabilitation
1 23 facility.
1 24 2. This section applies to the following classes of third-
1 25 party payment provider contracts or policies delivered, issued
1 26 for delivery, continued, or renewed in this state on or after
1 27 July 1, 2000:
1 28 a. Individual or group accident and sickness insurance
1 29 providing coverage on an expense-incurred basis.
1 30 b. An individual or group hospital or medical service
1 31 contract issued pursuant to chapter 509, 514, or 514A.
1 32 c. An individual or group health maintenance organization
1 33 contract regulated under chapter 514B.
1 34 d. An individual or group Medicare supplemental policy,
1 35 unless coverage pursuant to such policy is preempted by
2 1 federal law.
2 2 e. An organized delivery system licensed by the director
2 3 of public health.
2 4 f. Any other entity engaged in the business of insurance,
2 5 risk transfer, or risk retention, which is subject to the
2 6 jurisdiction of the commissioner.
2 7 3. For purposes of this section, unless the context
2 8 otherwise requires:
2 9 a. "Mental health or substance abuse condition" means a
2 10 condition or disorder involving mental illness or substance
2 11 abuse or other addictive disorder which is included in the
2 12 diagnostic categories listed in the mental disorders section
2 13 of the international classification of disease, as
2 14 periodically revised.
2 15 b. "Rates, terms, and conditions" means lifetime payment
2 16 limits, deductibles, copayments, coinsurance, and any other
2 17 cost-sharing requirements, out-of-pocket limits, visit
2 18 limitations, and any other financial component of benefits
2 19 coverage that affects the covered individual.
2 20 EXPLANATION
2 21 This bill creates new Code section 514C.14 and requires
2 22 coverage benefits under a policy or contract providing for
2 23 third-party payment or prepayment of health or medical
2 24 expenses for mental health and substance abuse conditions
2 25 based on rates, terms, and conditions which are no more
2 26 restrictive than the rates, terms, and conditions for coverage
2 27 benefits provided for other health or medical conditions. The
2 28 bill requires coverage for services provided by a licensed
2 29 mental health professional, or services provided in a licensed
2 30 hospital or health facility for the treatment of mental
2 31 illness; and for services provided by a qualified professional
2 32 as defined by rule of the Iowa department of public health, a
2 33 licensed health facility providing a program for the treatment
2 34 of substance abuse or other addictive disorder approved by the
2 35 Iowa department of public health, or a licensed substance
3 1 abuse treatment and rehabilitation facility for the treatment
3 2 of substance abuse or other addictive disorder.
3 3 The bill defines "rates, terms, and conditions" to include
3 4 lifetime payment limits, deductibles, copayments, coinsurance,
3 5 and any other cost-sharing requirements, out-of-pocket limits,
3 6 visit limitations, and any other financial component of
3 7 benefits coverage that affects the covered individual.
3 8 LSB 1460XS 78
3 9 mj/jw/5
Text: SF00082 Text: SF00084 Text: SF00000 - SF00099 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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