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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