Text: H08645 Text: H08647 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 30 the 1 3 follwing: 1 4 "Sec. . NEW SECTION. 509A.6A NEUROBIOLOGICAL 1 5 DISORDER AND SUBSTANCE ABUSE COVERAGE FOR STATE 1 6 EMPLOYEES. 1 7 1. A state health or medical group insurance plan 1 8 for state employees shall provide coverage benefits 1 9 for treatment services for neurobiological disorders 1 10 and substance abuse that shall be provided on terms 1 11 and conditions that are no more restrictive than the 1 12 terms and conditions for coverage benefits provided 1 13 for other medical conditions under such plan. 1 14 2. For purposes of this section: 1 15 a. "Neurobiological disorder" means the following: 1 16 (1) Schizophrenia and other psychotic disorders. 1 17 (2) Mood disorders. 1 18 (3) Anxiety disorders. 1 19 (4) Pervasive development disorders and attention 1 20 deficit. 1 21 b. "State employee" means a person who is a paid 1 22 employee of the state of Iowa, including a paid 1 23 employee of the state board of regents. 1 24 c. "State health or medical group insurance plan" 1 25 means as defined in section 509A.13A. 1 26 d. "Substance abuse" means a pattern of 1 27 pathological use of alcohol or a drug that causes 1 28 impairment in social or occupational functioning, or 1 29 that produces physiological dependency evidenced by 1 30 physical tolerance or by physical symptoms when the 1 31 alcohol or drug is withdrawn. 1 32 3. The commissioner, by rule, shall define the 1 33 neurobiological disorders identified in subsection 2. 1 34 Definitions established by the commissioner shall be 1 35 consistent with definitions provided in the most 1 36 recent edition of the American psychiatric 1 37 association's diagnostic and statistical manual of 1 38 mental disorders, as such definitions may be amended 1 39 from time to time. The commissioner may adopt the 1 40 definitions provided in such manual by reference. 1 41 4. This section shall not apply to accident only, 1 42 specified disease, short-term hospital or medical, 1 43 hospital confinement indemnity, credit, dental, 1 44 vision, Medicare supplement, long-term care, basic 1 45 hospital and medical-surgical expense coverage as 1 46 defined by the commissioner, disability income 1 47 insurance coverage, coverage issued as a supplement to 1 48 liability insurance, workers' compensation or similar 1 49 insurance, or automobile medical payment insurance, or 1 50 individual accident and sickness policies issued to 2 1 individuals or to individual members of a member 2 2 association. 2 3 5. A carrier, organized delivery system, or plan 2 4 may manage the benefits provided under this section 2 5 provided through common methods including, but not 2 6 limited to, providing payment of benefits or providing 2 7 care and treatment under a capitated payment system, 2 8 prospective reimbursement rate system, utilization 2 9 control system, incentive system for the use of least 2 10 restrictive and least costly levels of care, a 2 11 preferred provider contract limiting choice of 2 12 specific providers, or any other system, method, or 2 13 organization designed to ensure that services are 2 14 medically necessary and clinically appropriate. 2 15 6. a. A plan covered under this section shall not 2 16 impose an aggregate annual or lifetime limit on 2 17 neurobiological disorder or substance abuse coverage 2 18 benefits unless the plan imposes an aggregate annual 2 19 or lifetime limit on substantially all medical and 2 20 surgical coverage benefits. 2 21 b. A plan covered under this section that imposes 2 22 an aggregate annual or lifetime limit on substantially 2 23 all medical and surgical coverage benefits shall not 2 24 impose an aggregate annual or lifetime limit on 2 25 neurobiological disorder or substance abuse coverage 2 26 benefits which is less than the aggregate annual or 2 27 lifetime limit imposed on substantially all medical 2 28 and surgical coverage benefits. 2 29 7. A plan covered under this section shall at a 2 30 minimum allow for thirty inpatient days and fifty-two 2 31 outpatient visits annually. The plan may also include 2 32 deductibles, coinsurance, or copayments, provided the 2 33 amounts and extent of such deductibles, coinsurance, 2 34 or copayments applicable to other medical or surgical 2 35 services coverage under the plan are the same. It is 2 36 not a violation of this section if the plan excludes 2 37 entirely from coverage benefits for the cost of 2 38 providing the following: 2 39 a. Marital, family, educational, developmental, or 2 40 training services. 2 41 b. Care that is substantially custodial in nature. 2 42 c. Services and supplies that are not medically 2 43 necessary or clinically appropriate. 2 44 d. Experimental treatments. 2 45 8. This section applies to plans established 2 46 pursuant to this chapter delivered, issued for 2 47 delivery, continued, or renewed in this state on or 2 48 after January 1, 2003." 2 49 2 50 3 1 3 2 GRUNDBERG of Polk 3 3 HF 2623.713 79 3 4 jj/cls
Text: H08645 Text: H08647 Text: H08600 - H08699 Text: H Index Bills and Amendments: General Index Bill History: General Index
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