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Senate File 83

Partial Bill History

Bill Text

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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