Text: H08649 Text: H08651 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 following:
1 4 "Sec. . NEW SECTION. 509A.6A NEUROBIOLOGICAL
1 5 DISORDER COVERAGE FOR STATE EMPLOYEES.
1 6 1. A state health or medical group insurance plan
1 7 for state employees shall provide coverage benefits
1 8 for treatment services for neurobiological disorders
1 9 that shall be provided on terms and conditions that
1 10 are no more restrictive than the terms and conditions
1 11 for coverage benefits provided for other medical
1 12 conditions under such plan.
1 13 2. For purposes of this section:
1 14 a. "Neurobiological disorder" means the following:
1 15 (1) Schizophrenia and other psychotic disorders.
1 16 (2) Mood disorders.
1 17 (3) Anxiety disorders.
1 18 (4) Pervasive development disorders and attention
1 19 deficit.
1 20 b. "State employee" means a person who is a paid
1 21 employee of the state of Iowa, including a paid
1 22 employee of the state board of regents.
1 23 c. "State health or medical group insurance plan"
1 24 means as defined in section 509A.13A.
1 25 3. The commissioner, by rule, shall define the
1 26 neurobiological disorder identified in subsection 2.
1 27 Definitions established by the commissioner shall be
1 28 consistent with definitions provided in the most
1 29 recent edition of the American psychiatric
1 30 association's diagnostic and statistical manual of
1 31 mental disorders, as such definitions may be amended
1 32 from time to time. The commissioner may adopt the
1 33 definitions provided in such manual by reference.
1 34 4. This section shall not apply to accident only,
1 35 specified disease, short-term hospital or medical,
1 36 hospital confinement indemnity, credit, dental,
1 37 vision, Medicare supplement, long-term care, basic
1 38 hospital and medical-surgical expense coverage as
1 39 defined by the commissioner, disability income
1 40 insurance coverage, coverage issued as a supplement to
1 41 liability insurance, workers' compensation or similar
1 42 insurance, or automobile medical payment insurance, or
1 43 individual accident and sickness policies issued to
1 44 individuals or to individual members of a member
1 45 association.
1 46 5. A carrier, organized delivery system, or plan
1 47 may manage the benefits provided under this section
1 48 provided through common methods including, but not
1 49 limited to, providing payment of benefits or providing
1 50 care and treatment under a capitated payment system,
2 1 prospective reimbursement rate system, utilization
2 2 control system, incentive system for the use of least
2 3 restrictive and least costly levels of care, a
2 4 preferred provider contract limiting choice of
2 5 specific providers, or any other system, method, or
2 6 organization designed to ensure that services are
2 7 medically necessary and clinically appropriate.
2 8 6. a. A plan covered under this section shall not
2 9 impose an aggregate annual or lifetime limit on
2 10 neurobiological disorder coverage benefits unless the
2 11 plan imposes an aggregate annual or lifetime limit on
2 12 substantially all medical and surgical coverage
2 13 benefits.
2 14 b. A plan covered under this section that imposes
2 15 an aggregate annual or lifetime limit on substantially
2 16 all medical and surgical coverage benefits shall not
2 17 impose an aggregate annual or lifetime limit on
2 18 neurobiological disorder coverage benefits which is
2 19 less than the aggregate annual or lifetime limit
2 20 imposed on substantially all medical and surgical
2 21 coverage benefits.
2 22 7. A plan covered under this section shall at a
2 23 minimum allow for thirty inpatient days and fifty-two
2 24 outpatient visits annually. The plan may also include
2 25 deductibles, coinsurance, or copayments, provided the
2 26 amounts and extent of such deductibles, coinsurance,
2 27 or copayments applicable to other medical or surgical
2 28 services coverage under the plan are the same. It is
2 29 not a violation of this section if the plan excludes
2 30 entirely from coverage benefits for the cost of
2 31 providing the following:
2 32 a. Marital, family, educational, developmental, or
2 33 training services.
2 34 b. Care that is substantially custodial in nature.
2 35 c. Services and supplies that are not medically
2 36 necessary or clinically appropriate.
2 37 d. Experimental treatments.
2 38 8. This section applies to plans established
2 39 pursuant to this chapter delivered, issued for
2 40 delivery, continued, or renewed in this state on or
2 41 after January 1, 2003."
2 42
2 43
2 44
2 45 GRUNDBERG of Polk
2 46 HF 2623.511 79
2 47 jj/pj
Text: H08649 Text: H08651 Text: H08600 - H08699 Text: H Index Bills and Amendments: General Index Bill History: General Index
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