Text: H08683 Text: H08685 Text: H08600 - H08699 Text: H Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend the amendment, H-8683, to House File 2623 as
1 2 follows:
1 3 #1. By striking page 1, line 4, through page 4,
1 4 line 2, and inserting the following:
1 5 ""Sec. . NEW SECTION. 514C.21 MANDATED
1 6 COVERAGE FOR NEUROBIOLOGICAL DISORDERS AND UNDERLYING
1 7 CO-MORBIDITY.
1 8 1. For purposes of this section, unless the
1 9 context otherwise requires:
1 10 a. "Co-morbidity" means the coexistence of
1 11 conditions or diagnosable disorders such as
1 12 neurobiological disorders and substance abuse. For
1 13 purposes of this section, "substance abuse" means a
1 14 pattern of pathological use of alcohol or a drug that
1 15 causes impairment in social or occupational
1 16 functioning, or that produces physiological dependency
1 17 evidenced by physical tolerance or by physical
1 18 symptoms when the alcohol or drug is withdrawn.
1 19 b. "Neurobiological disorder" means the following:
1 20 (1) Schizophrenia and other psychotic disorders.
1 21 (2) Affective disorders.
1 22 (3) Anxiety disorders.
1 23 (4) Pervasive developmental disorders.
1 24 (5) Attention deficit hyperactivity disorder and
1 25 related disorders.
1 26 (6) Disorders identified in childhood and
1 27 adolescence.
1 28 The commissioner, by rule, shall identify the
1 29 neurobiological disorders covered by this definition,
1 30 consistent with the guidelines provided in the most
1 31 recent edition of the American psychiatric
1 32 association's diagnostic and statistical manual of
1 33 mental disorders, as such definitions may be amended
1 34 from time to time. The commissioner may adopt the
1 35 definitions provided in the manual by reference.
1 36 c. "Rates, terms, and conditions" means any
1 37 lifetime or annual payment limits, deductibles,
1 38 copayments, coinsurance, and any other cost-sharing
1 39 requirements, out-of-pocket limits, visit limitations,
1 40 and any other financial component of benefits coverage
1 41 that affects the covered individual.
1 42 2. a. Notwithstanding the uniformity of treatment
1 43 requirements of section 514C.6, a policy, contract, or
1 44 plan providing for third-party payment or prepayment
1 45 of health or medical expenses shall provide coverage
1 46 benefits for treatment for neurobiological disorders
1 47 and underlying co-morbidity based on rates, terms, and
1 48 conditions that are no more restrictive than the
1 49 rates, terms, and conditions for coverage benefits
1 50 provided for other health or medical conditions under
2 1 the policy, contract, or plan.
2 2 b. Any restrictions or limitations with respect to
2 3 rates, terms, and conditions involving deductibles,
2 4 copayments, coinsurance, and any other cost-sharing
2 5 requirements shall be cumulative for coverage of
2 6 treatment for neurobiological disorders and underlying
2 7 co-morbidity and other health or medical conditions
2 8 under a policy, contract, or plan. A policy,
2 9 contract, or plan subject to this section shall not
2 10 impose an aggregate lifetime or annual limit on
2 11 treatment for neurobiological disorders and underlying
2 12 co-morbidity coverage benefits unless the policy,
2 13 contract, or plan imposes an aggregate lifetime or
2 14 annual limit on substantially all health or medical
2 15 coverage benefits. A policy, contract, or plan
2 16 subject to this section that imposes an aggregate
2 17 lifetime or annual limit on substantially all medical
2 18 and surgical coverage benefits shall not impose an
2 19 aggregate lifetime or annual limit on treatment for
2 20 neurobiological disorders and underlying co-morbidity
2 21 coverage benefits that is less than the aggregate
2 22 lifetime or annual limit imposed on substantially all
2 23 health or medical coverage benefits.
2 24 c. Coverage required under this section shall be
2 25 for the treatment of neurobiological disorders and
2 26 underlying co-morbidity, for services provided by a
2 27 health professional licensed under chapter 147A, 148,
2 28 150A, 152, 154B, 154C, or 154D, for services provided
2 29 in a hospital, clinic, office, community mental health
2 30 center, health care facility, outpatient treatment
2 31 facility, residential treatment facility, halfway
2 32 house, or similar facility for the provision of health
2 33 care services, and for services provided pursuant to
2 34 the comprehensive program for treatment for substance
2 35 abuse maintained by the department of public health
2 36 pursuant to section 125.12 in a hospital licensed
2 37 under chapter 135B or a facility licensed under
2 38 chapter 125.
2 39 3. This section applies to the following classes
2 40 of third-party payment provider policies, contracts,
2 41 or plans delivered, issued for delivery, continued, or
2 42 renewed in this state on or after January 1, 2003:
2 43 a. Individual or group accident and sickness
2 44 insurance providing coverage on an expense-incurred
2 45 basis.
2 46 b. An individual or group hospital or medical
2 47 service contract issued pursuant to chapter 509, 514,
2 48 or 514A.
2 49 c. A plan established pursuant to chapter 509A for
2 50 public employees.
3 1 d. An individual or group health maintenance
3 2 organization contract regulated under chapter 514B.
3 3 e. An individual or group Medicare supplemental
3 4 policy, unless coverage pursuant to such policy is
3 5 preempted by federal law.
3 6 f. Any other entity engaged in the business of
3 7 insurance, risk transfer, or risk retention, which is
3 8 subject to the jurisdiction of the commissioner.
3 9 g. An organized delivery system licensed by the
3 10 director of public health.
3 11 4. The commissioner shall adopt rules pursuant to
3 12 chapter 17A to administer this section.
3 13 Sec. . INSURANCE DIVISION STUDY IN CONJUNCTION
3 14 WITH STATE AUDITOR.
3 15 1. The insurance division of the department of
3 16 commerce, in conjunction with the state auditor, shall
3 17 conduct a study of the cost of providing
3 18 neurobiological disorder coverage benefits in Iowa.
3 19 2. The study shall assess at least all of the
3 20 following:
3 21 a. Identification of the costs attributed to
3 22 treatment of neurobiological disorders, and to
3 23 underlying co-morbidity.
3 24 b. An estimate of the impact of mandated coverage
3 25 on health care coverage benefit costs and
3 26 availability.
3 27 c. Actions taken by the division to ensure that
3 28 third-party payors subject to this Act are in
3 29 compliance.
3 30 d. Identification of any segments of the
3 31 population of this state that may be excluded from, or
3 32 have limited access to, treatment, including the
3 33 number of citizens that may be excluded from, or have
3 34 limited access to, treatment under third-party payor
3 35 policies or contracts provided by employers who
3 36 receive substantial revenue from public sources.
3 37 3. The insurance division shall submit a written
3 38 report to the general assembly on or before January
3 39 30, 2005.
3 40 Sec. . DEPARTMENT OF PUBLIC HEALTH STUDY.
3 41 1. The department of public health shall conduct a
3 42 two-year study of the mental health delivery system in
3 43 Iowa, beginning July 1, 2002.
3 44 2. The study shall include participation by at
3 45 least all of the following:
3 46 a. Representatives of professional health care
3 47 groups licensed under chapters 147A, 148, 150A, 152,
3 48 154B, 154C, and 154D.
3 49 b. Representatives of associations or other groups
3 50 representing hospitals, clinics, community mental
4 1 health centers, community corrections and prison
4 2 corrections, health care facilities, outpatient
4 3 treatment facilities, and any other facility offering
4 4 mental health services.
4 5 c. County supervisors, representatives from the
4 6 department of human services, judges, mental health
4 7 advocates, and other state or county officials
4 8 involved in the provision of mental health services.
4 9 d. Consumers, family members, and patients.
4 10 3. The participants in the study shall assess the
4 11 relevant issues facing the mental health delivery
4 12 system in Iowa, and shall prepare a report with
4 13 recommendations for presentation to the general
4 14 assembly no later than November 1, 2004.""
4 15 #2. By renumbering, redesignating, and correcting
4 16 internal references as necessary.
4 17
4 18
4 19
4 20 JOCHUM of Dubuque
4 21 HF 2623.214 79
4 22 jp/sh
Text: H08683 Text: H08685 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
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