Text: H08543 Text: H08545 Text: H08500 - H08599 Text: H Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend Senate File 2326, as passed by the Senate, as
1 2 follows:
1 3 #1. Page 176, by inserting after line 11 the
1 4 following:
1 5 "DIVISION
1 6 HEALTH COVERAGE
1 7 Sec. . NEW SECTION. 514C.21 MANDATED COVERAGE
1 8 FOR NEUROBIOLOGICAL DISORDERS AND UNDERLYING CO-
1 9 MORBIDITY.
1 10 1. For purposes of this section, unless the
1 11 context otherwise requires:
1 12 a. "Co-morbidity" means the coexistence of
1 13 conditions or diagnosable disorders such as
1 14 neurobiological disorders and substance abuse. For
1 15 purposes of this section, "substance abuse" means a
1 16 pattern of pathological use of alcohol or a drug that
1 17 causes impairment in social or occupational
1 18 functioning, or that produces physiological dependency
1 19 evidenced by physical tolerance or by physical
1 20 symptoms when the alcohol or drug is withdrawn.
1 21 b. "Neurobiological disorder" means the following:
1 22 (1) Schizophrenia and other psychotic disorders.
1 23 (2) Affective disorders.
1 24 (3) Anxiety disorders.
1 25 (4) Pervasive developmental disorders.
1 26 (5) Attention deficit hyperactivity disorder and
1 27 related disorders.
1 28 (6) Disorders identified in childhood and
1 29 adolescence.
1 30 The commissioner, by rule, shall identify the
1 31 neurobiological disorders covered by this definition,
1 32 consistent with the guidelines provided in the most
1 33 recent edition of the American psychiatric
1 34 association's diagnostic and statistical manual of
1 35 mental disorders, as such definitions may be amended
1 36 from time to time. The commissioner may adopt the
1 37 definitions provided in the manual by reference.
1 38 c. "Rates, terms, and conditions" means any
1 39 lifetime or annual payment limits, deductibles,
1 40 copayments, coinsurance, and any other cost-sharing
1 41 requirements, out-of-pocket limits, visit limitations,
1 42 and any other financial component of benefits coverage
1 43 that affects the covered individual.
1 44 2. a. Notwithstanding the uniformity of treatment
1 45 requirements of section 514C.6, a policy, contract, or
1 46 plan providing for third-party payment or prepayment
1 47 of health or medical expenses shall provide coverage
1 48 benefits for treatment for neurobiological disorders
1 49 and underlying co-morbidity based on rates, terms, and
1 50 conditions that are no more restrictive than the
2 1 rates, terms, and conditions for coverage benefits
2 2 provided for other health or medical conditions under
2 3 the policy, contract, or plan.
2 4 b. Any restrictions or limitations with respect to
2 5 rates, terms, and conditions involving deductibles,
2 6 copayments, coinsurance, and any other cost-sharing
2 7 requirements shall be cumulative for coverage of
2 8 treatment for neurobiological disorders and underlying
2 9 co-morbidity and other health or medical conditions
2 10 under a policy, contract, or plan. A policy,
2 11 contract, or plan subject to this section shall not
2 12 impose an aggregate lifetime or annual limit on
2 13 treatment for neurobiological disorders and underlying
2 14 co-morbidity coverage benefits unless the policy,
2 15 contract, or plan imposes an aggregate lifetime or
2 16 annual limit on substantially all health or medical
2 17 coverage benefits. A policy, contract, or plan
2 18 subject to this section that imposes an aggregate
2 19 lifetime or annual limit on substantially all medical
2 20 and surgical coverage benefits shall not impose an
2 21 aggregate lifetime or annual limit on treatment for
2 22 neurobiological disorders and underlying co-morbidity
2 23 coverage benefits that is less than the aggregate
2 24 lifetime or annual limit imposed on substantially all
2 25 health or medical coverage benefits.
2 26 c. Coverage required under this section shall be
2 27 for the treatment of neurobiological disorders and
2 28 underlying co-morbidity, for services provided by a
2 29 health professional licensed under chapter 147A, 148,
2 30 150A, 152, 154B, 154C, or 154D, for services provided
2 31 in a hospital, clinic, office, community mental health
2 32 center, health care facility, outpatient treatment
2 33 facility, residential treatment facility, halfway
2 34 house, or similar facility for the provision of health
2 35 care services, and for services provided pursuant to
2 36 the comprehensive program for treatment for substance
2 37 abuse maintained by the department of public health
2 38 pursuant to section 125.12 in a hospital licensed
2 39 under chapter 135B or a facility licensed under
2 40 chapter 125.
2 41 3. This section applies to the following classes
2 42 of third-party payment provider policies, contracts,
2 43 or plans delivered, issued for delivery, continued, or
2 44 renewed in this state on or after January 1, 2003:
2 45 a. Individual or group accident and sickness
2 46 insurance providing coverage on an expense-incurred
2 47 basis.
2 48 b. An individual or group hospital or medical
2 49 service contract issued pursuant to chapter 509, 514,
2 50 or 514A.
3 1 c. A plan established pursuant to chapter 509A for
3 2 public employees.
3 3 d. An individual or group health maintenance
3 4 organization contract regulated under chapter 514B.
3 5 e. An individual or group Medicare supplemental
3 6 policy, unless coverage pursuant to such policy is
3 7 preempted by federal law.
3 8 f. Any other entity engaged in the business of
3 9 insurance, risk transfer, or risk retention, which is
3 10 subject to the jurisdiction of the commissioner.
3 11 g. An organized delivery system licensed by the
3 12 director of public health.
3 13 4. The commissioner shall adopt rules pursuant to
3 14 chapter 17A to administer this section.
3 15 Sec. . INSURANCE DIVISION STUDY IN CONJUNCTION
3 16 WITH STATE AUDITOR.
3 17 1. The insurance division of the department of
3 18 commerce, in conjunction with the state auditor, shall
3 19 conduct a study of the cost of providing
3 20 neurobiological disorder coverage benefits in Iowa.
3 21 2. The study shall assess at least all of the
3 22 following:
3 23 a. Identification of the costs attributed to
3 24 treatment of neurobiological disorders, and to
3 25 underlying co-morbidity.
3 26 b. An estimate of the impact of mandated coverage
3 27 on health care coverage benefit costs and
3 28 availability.
3 29 c. Actions taken by the division to ensure that
3 30 third-party payors subject to this Act are in
3 31 compliance.
3 32 d. Identification of any segments of the
3 33 population of this state that may be excluded from, or
3 34 have limited access to, treatment, including the
3 35 number of citizens that may be excluded from, or have
3 36 limited access to, treatment under third-party payor
3 37 policies or contracts provided by employers who
3 38 receive substantial revenue from public sources.
3 39 3. The insurance division shall submit a written
3 40 report to the general assembly on or before January
3 41 30, 2005.
3 42 Sec. . DEPARTMENT OF PUBLIC HEALTH STUDY.
3 43 1. The department of public health shall conduct a
3 44 two-year study of the mental health delivery system in
3 45 Iowa, beginning July 1, 2002.
3 46 2. The study shall include participation by at
3 47 least all of the following:
3 48 a. Representatives of professional health care
3 49 groups licensed under chapters 147A, 148, 150A, 152,
3 50 154B, 154C, and 154D.
4 1 b. Representatives of associations or other groups
4 2 representing hospitals, clinics, community mental
4 3 health centers, community corrections and prison
4 4 corrections, health care facilities, outpatient
4 5 treatment facilities, and any other facility offering
4 6 mental health services.
4 7 c. County supervisors, representatives from the
4 8 department of human services, judges, mental health
4 9 advocates, and other state or county officials
4 10 involved in the provision of mental health services.
4 11 d. Consumers, family members, and patients.
4 12 3. The participants in the study shall assess the
4 13 relevant issues facing the mental health delivery
4 14 system in Iowa, and shall prepare a report with
4 15 recommendations for presentation to the general
4 16 assembly no later than November 1, 2004."
4 17 #2. By renumbering as necessary.
4 18
4 19
4 20
4 21 ATTEBERRY of Delaware
4 22
4 23
4 24 SMITH of Marshall
4 25
4 26
4 27
4 28 JOCHUM of Dubuque
4 29 SF 2326.710 79
4 30 jj/cls
Text: H08543 Text: H08545 Text: H08500 - H08599 Text: H Index Bills and Amendments: General Index Bill History: General Index
© 2002 Cornell College and League of Women Voters of Iowa
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