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1 31 alcohol or drug is withdrawn.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
© 2002 Cornell College and League of Women Voters of Iowa
Comments about this site or page?
webmaster@legis.iowa.gov.
Please remember that the person listed above does not vote on bills. Direct all comments concerning legislation to State Legislators.
Last update: Tue Apr 16 13:27:52 CDT 2002
URL: /DOCS/GA/79GA/Legislation/H/08600/H08646/020411.html
jhf