Text: H08643 Text: H08645 Text: H08600 - H08699 Text: H Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend House File 2623 as follows:
1 2 #1. Page 9, by inserting after line 28 the
1 3 following:
1 4 "Sec. . NEW SECTION. 514C.21 NEUROBIOLOGICAL
1 5 DISORDER.
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 issued by a
1 10 carrier, as defined in section 513B.2, or by an
1 11 organized delivery system authorized under 1993 Iowa
1 12 Acts, chapter 158, shall provide coverage benefits for
1 13 treatment of a neurobiological disorder if either of
1 14 the following is satisfied:
1 15 a. The policy or contract is issued to an employer
1 16 who on at least fifty percent of the employer's
1 17 working days during the preceding calendar year
1 18 employed more than fifty full-time equivalent
1 19 employees. In determining the number of full-time
1 20 equivalent employees of an employer, employers who are
1 21 affiliated or who are able to file a consolidated tax
1 22 return for purposes of state taxation shall be
1 23 considered one employer.
1 24 b. The policy or contract is issued to a small
1 25 employer as defined in section 513B.2, and such policy
1 26 or contract provides coverage benefits for the
1 27 treatment of neurobiological disorder.
1 28 2. Notwithstanding the uniformity of treatment
1 29 requirements of section 514C.6, a plan established
1 30 pursuant to chapter 509A for public employees shall
1 31 provide coverage benefits for treatment of a
1 32 neurobiological disorder.
1 33 3. For purposes of this section:
1 34 a. "Neurobiological disorder" means the following:
1 35 (1) Schizophrenia and other psychotic disorders.
1 36 (2) Mood disorders.
1 37 (3) Anxiety disorders.
1 38 (4) Pervasive developmental disorders and
1 39 attention deficit.
1 40 b. "Substance abuse" means a pattern of
1 41 pathological use of alcohol or a drug that causes
1 42 impairment in social or occupational functioning, or
1 43 that produces physiological dependency evidenced by
1 44 physical tolerance or by physical symptoms when the
1 45 alcohol or drug is withdrawn.
1 46 4. The commissioner, by rule, shall define the
1 47 neurobiological disorders identified in subsection 3.
1 48 Definitions established by the commissioner shall be
1 49 consistent with definitions provided in the most
1 50 recent edition of the American psychiatric
2 1 association's diagnostic and statistical manual of
2 2 mental disorders, as the definitions may be amended
2 3 from time to time. The commissioner may adopt the
2 4 definitions provided in such manual by reference.
2 5 5. This section shall not apply to accident only,
2 6 specified disease, short-term hospital or medical,
2 7 hospital confinement indemnity, credit, dental,
2 8 vision, Medicare supplement, long-term care, basic
2 9 hospital and medical-surgical expense coverage as
2 10 defined by the commissioner, disability income
2 11 insurance coverage, coverage issued as a supplement to
2 12 liability insurance, workers' compensation or similar
2 13 insurance, or automobile medical payment insurance, or
2 14 individual accident and sickness policies issued to
2 15 individuals or to individual members of a member
2 16 association.
2 17 6. A carrier, organized delivery system, or plan
2 18 established pursuant to chapter 509A may manage the
2 19 benefits provided through common methods including,
2 20 but not limited to, providing payment of benefits or
2 21 providing care and treatment under a capitated payment
2 22 system, prospective reimbursement rate system,
2 23 utilization control system, incentive system for the
2 24 use of least restrictive and least costly levels of
2 25 care, a preferred provider contract limiting choice of
2 26 specific providers, or any other system, method, or
2 27 organization designed to assure services are medically
2 28 necessary and clinically appropriate.
2 29 7. a. A group policy or contract or plan covered
2 30 under this section shall not impose an aggregate
2 31 annual or lifetime limit on neurobiological disorder
2 32 coverage benefits unless the policy or contract or
2 33 plan imposes an aggregate annual or lifetime limit on
2 34 substantially all medical and surgical coverage
2 35 benefits.
2 36 b. A group policy or contract or plan covered
2 37 under this section that imposes an aggregate annual or
2 38 lifetime limit on substantially all medical and
2 39 surgical coverage benefits shall not impose an
2 40 aggregate annual or lifetime limit on neurobiological
2 41 disorder coverage benefits which is less than the
2 42 aggregate annual or lifetime limit imposed on
2 43 substantially all medical and surgical coverage
2 44 benefits.
2 45 8. A group policy or contract or plan covered
2 46 under this section shall at a minimum allow for thirty
2 47 inpatient days and fifty-two outpatient visits
2 48 annually. The policy or contract or plan may also
2 49 include deductibles, coinsurance, or copayments,
2 50 provided the amounts and extent of such deductibles,
3 1 coinsurance, or copayments applicable to other medical
3 2 or surgical services coverage under the policy or
3 3 contract or plan are the same. It is not a violation
3 4 of this section if the policy or contract or plan
3 5 excludes entirely from coverage benefits for the cost
3 6 of providing the following:
3 7 a. Marital, family, educational, developmental, or
3 8 training services.
3 9 b. Care that is substantially custodial in nature.
3 10 c. Services and supplies that are not medically
3 11 necessary or clinically appropriate.
3 12 d. Experimental treatments.
3 13 9. This section applies to third-party payment
3 14 provider policies or contracts and plans established
3 15 pursuant to chapter 509A delivered, issued for
3 16 delivery, continued, or renewed in this state on or
3 17 after January 1, 2003."
3 18 #2. Page 25, by inserting after line 17 the
3 19 following:
3 20 "Sec. . INSURANCE DIVISION STUDY.
3 21 1. The insurance division of the department of
3 22 commerce shall conduct a study to determine the impact
3 23 of providing coverage for substance abuse. The
3 24 division shall include in the study all of the
3 25 following:
3 26 a. An estimate of the impact of mandated coverage
3 27 for substance abuse treatment on health care coverage
3 28 benefit costs.
3 29 b. Actions taken by the division to ensure that
3 30 third-party payors subject to section 514C.21, if
3 31 enacted by this Act are in compliance, and that the
3 32 quality of and access to treatment for substance abuse
3 33 are not compromised by providing for coverage parity
3 34 with other coverage benefits provided for other health
3 35 or medical conditions under third-party payor
3 36 contracts or policies.
3 37 c. An analysis and comparison of the choices for
3 38 treatment of substance abuse with regard to level of
3 39 access, choice, and financial burden on the
3 40 individual.
3 41 d. Identification of any segments of the
3 42 population of this state that may be excluded from, or
3 43 have limited access to, treatment for substance abuse,
3 44 including the number of citizens that may be excluded
3 45 from, or have limited access to, treatment under
3 46 third-party payor policies or contracts provided by
3 47 employers who receive substantial revenue from public
3 48 sources.
3 49 2. The insurance division shall submit a written
3 50 report to the general assembly on or before January
4 1 15, 2003."
4 2 #3. By renumbering as necessary.
4 3
4 4
4 5
4 6 GRUNDBERG of Polk
4 7 HF 2623.711 79
4 8 jj/cls
Text: H08643 Text: H08645 Text: H08600 - H08699 Text: H Index Bills and Amendments: General Index Bill History: General Index
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