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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
1 12 during at least fifty percent of the employer's working days
1 13 during the preceding calendar year, employed more than fifty
1 14 full-time equivalent employees. In determining the number of
1 15 full-time equivalent employees of an employer, employers who
1 16 are affiliated or who are able to file a consolidated tax
1 17 return 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. This section shall not apply to accident only,
2 2 specified disease, short-term hospital or medical, hospital
2 3 confinement indemnity, credit, dental, vision, Medicare
2 4 supplement, long-term care, basic hospital and medical-
2 5 surgical expense coverage as defined by the commissioner,
2 6 disability income insurance coverage, coverage issued as a
2 7 supplement to liability insurance, workers' compensation or
2 8 similar insurance, or automobile medical payment insurance, or
2 9 individual accident and sickness policies issued to
2 10 individuals or to individual members of a member association.
2 11 5. A carrier, organized delivery system, or plan
2 12 established pursuant to chapter 509A may manage the benefits
2 13 provided through common methods including, but not limited to,
2 14 providing payment of benefits or providing care and treatment
2 15 under a capitated payment system, prospective reimbursement
2 16 rate system, utilization control system, incentive system for
2 17 the use of least restrictive and least costly levels of care,
2 18 a preferred provider contract limiting choice of specific
2 19 providers, or any other system, method, or organization
2 20 designed to assure services are medically necessary and
2 21 clinically appropriate.
2 22 6. A group policy or contract or plan covered under this
2 23 section shall at a minimum allow for thirty inpatient days and
2 24 fifty-two outpatient visits annually. The policy or contract
2 25 or plan may also include deductibles, coinsurance, or
2 26 copayments if such deductibles, coinsurance, or copayments are
2 27 applicable to other medical or surgical services coverage
2 28 under the policy or contract or plan.
2 29 7. A group policy is exempt from this section upon
2 30 submitting to the commissioner evidence demonstrating a
2 31 premium increase for the policy term in excess of three
2 32 percent as a result of the requirements of this section.
2 33 8. This section applies to third-party payment provider
2 34 policies or contracts and plans established pursuant to
2 35 chapter 509A delivered, issued for delivery, continued, or
3 1 renewed in this state on or after July 1, 2001.
3 2 9. This section is repealed effective July 1, 2003.
3 3 Sec. 2. MENTAL HEALTH BENEFITS. The insurance
3 4 commissioner, pursuant to the commissioner's authority under
3 5 section 513B.14, shall increase the lifetime maximum benefit
3 6 for mental health services under a standard health benefit
3 7 plan provided under 191 IAC 71.14 from fifty thousand dollars
3 8 to one hundred thousand dollars. The increase shall be made
3 9 effective for a standard health benefit plan delivered, issued
3 10 for delivery, continued, or renewed in this state on or after
3 11 July 1, 2000.
3 12 EXPLANATION
3 13 This bill creates a new Code section 514C.19 and provides
3 14 that a group policy or contract providing for third-party
3 15 payment or prepayment of health or medical expenses issued by
3 16 a carrier, as defined in Code section 513B.2, or by an
3 17 organized delivery system authorized under 1993 Iowa Acts,
3 18 chapter 158, shall provide coverage benefits for treatment of
3 19 a biologically based mental illness if the policy or contract
3 20 is issued to an employer who, during at least 50 percent of
3 21 the employer's working days during the preceding calendar
3 22 year, employed more than 50 full-time equivalent employees; if
3 23 the policy or contract is issued to a small employer as
3 24 defined in Code section 513B.2, and such policy or contract
3 25 provides coverage benefits for the treatment of mental
3 26 illness; or if the plan is established pursuant to Code
3 27 chapter 509A for public employees.
3 28 The bill defines "biologically based mental illness" as
3 29 psychiatric illnesses including schizophrenia, bipolar
3 30 disorders, major depressive disorders, schizo-affective
3 31 disorders, obsessive-compulsive disorders, pervasive
3 32 developmental disorders, and autistic disorders.
3 33 The bill provides that a carrier, organized delivery
3 34 system, or plan established pursuant to Code chapter 509A may
3 35 manage the benefits provided through common methods including,
4 1 but not limited to, providing payment of benefits or providing
4 2 care and treatment under a capitated payment system,
4 3 prospective reimbursement rate system, utilization control
4 4 system, incentive system for the use of least restrictive and
4 5 least costly levels of care, a preferred provider contract
4 6 limiting choice of specific providers, or any other system,
4 7 method, or organization designed to assure services are
4 8 medically necessary and clinically appropriate.
4 9 The bill provides that a group policy is exempt from this
4 10 new Code section upon submitting to the commissioner evidence
4 11 demonstrating a premium increase for the policy term in excess
4 12 of 3 percent as a result of the requirements of this section.
4 13 The bill provides that the new Code section created applies
4 14 to third-party payment provider contracts or policies and
4 15 public employer plans delivered, issued for delivery,
4 16 continued, or renewed in this state on or after July 1, 2001.
4 17 The bill directs the insurance commissioner to increase the
4 18 lifetime maximum benefit for mental health services under a
4 19 standard health benefit plan from $50,000 to $100,000.
4 20 The bill provides that the new Code section is repealed
4 21 effective July 1, 2003.
4 22 LSB 6283SV 78
4 23 mj/cf/24
Text: SF02411 Text: SF02413 Text: SF02400 - SF02499 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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