Text: HF00106 Text: HF00108 Text: HF00100 - HF00199 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 514C.21 NEUROBIOLOGICAL
1 2 DISORDER.
1 3 1. Notwithstanding the uniformity of treatment
1 4 requirements of section 514C.6, a group policy or contract
1 5 providing for third-party payment or prepayment of health or
1 6 medical expenses issued by a carrier, as defined in section
1 7 513B.2, or by an organized delivery system authorized under
1 8 1993 Iowa Acts, chapter 158, shall provide coverage benefits
1 9 for treatment of a neurobiological disorder if either of the
1 10 following is satisfied:
1 11 a. The policy or contract is issued to an employer who on
1 12 at least fifty percent of the employer's working days during
1 13 the preceding calendar year employed more than fifty full-time
1 14 equivalent employees. In determining the number of full-time
1 15 equivalent employees of an employer, employers who are
1 16 affiliated or who are able to file a consolidated tax return
1 17 for purposes of state taxation shall be considered one
1 18 employer.
1 19 b. The policy or contract is issued to a small employer as
1 20 defined in section 513B.2, and such policy or contract
1 21 provides coverage benefits for the treatment of
1 22 neurobiological disorder.
1 23 2. Notwithstanding the uniformity of treatment
1 24 requirements of section 514C.6, a plan established pursuant to
1 25 chapter 509A for public employees shall provide coverage
1 26 benefits for treatment of a neurobiological disorder.
1 27 3. For purposes of this section:
1 28 a. "Neurobiological disorder" means the following:
1 29 (1) Schizophrenia and other psychotic disorders.
1 30 (2) Mood disorders.
1 31 (3) Anxiety disorders.
1 32 (4) Pervasive developmental disorders and attention
1 33 deficit.
1 34 b. "Substance abuse" means a pattern of pathological use
1 35 of alcohol or a drug that causes impairment in social or
2 1 occupational functioning, or that produces physiological
2 2 dependency evidenced by physical tolerance or by physical
2 3 symptoms when the alcohol or drug is withdrawn.
2 4 4. The commissioner, by rule, shall define the
2 5 neurobiological disorders identified in subsection 3.
2 6 Definitions established by the commissioner shall be
2 7 consistent with definitions provided in the most recent
2 8 edition of the American psychiatric association's diagnostic
2 9 and statistical manual of mental disorders, as the definitions
2 10 may be amended from time to time. The commissioner may adopt
2 11 the definitions provided in such manual by reference.
2 12 5. This section shall not apply to accident only,
2 13 specified disease, short-term hospital or medical, hospital
2 14 confinement indemnity, credit, dental, vision, Medicare
2 15 supplement, long-term care, basic hospital and medical-
2 16 surgical expense coverage as defined by the commissioner,
2 17 disability income insurance coverage, coverage issued as a
2 18 supplement to liability insurance, workers' compensation or
2 19 similar insurance, or automobile medical payment insurance, or
2 20 individual accident and sickness policies issued to
2 21 individuals or to individual members of a member association.
2 22 6. A carrier, organized delivery system, or plan
2 23 established pursuant to chapter 509A may manage the benefits
2 24 provided through common methods including, but not limited to,
2 25 providing payment of benefits or providing care and treatment
2 26 under a capitated payment system, prospective reimbursement
2 27 rate system, utilization control system, incentive system for
2 28 the use of least restrictive and least costly levels of care,
2 29 a preferred provider contract limiting choice of specific
2 30 providers, or any other system, method, or organization
2 31 designed to assure services are medically necessary and
2 32 clinically appropriate.
2 33 7. a. A group policy or contract or plan covered under
2 34 this section shall not impose an aggregate annual or lifetime
2 35 limit on neurobiological disorder coverage benefits unless the
3 1 policy or contract or plan imposes an aggregate annual or
3 2 lifetime limit on substantially all medical and surgical
3 3 coverage benefits.
3 4 b. A group policy or contract or plan covered under this
3 5 section that imposes an aggregate annual or lifetime limit on
3 6 substantially all medical and surgical coverage benefits shall
3 7 not impose an aggregate annual or lifetime limit on
3 8 neurobiological disorder coverage benefits which is less than
3 9 the aggregate annual or lifetime limit imposed on
3 10 substantially all medical and surgical coverage benefits.
3 11 8. A group policy or contract or plan covered under this
3 12 section shall at a minimum allow for thirty inpatient days and
3 13 fifty-two outpatient visits annually. The policy or contract
3 14 or plan may also include deductibles, coinsurance, or
3 15 copayments, provided the amounts and extent of such
3 16 deductibles, coinsurance, or copayments applicable to other
3 17 medical or surgical services coverage under the policy or
3 18 contract or plan are the same. It is not a violation of this
3 19 section if the policy or contract or plan excludes entirely
3 20 from coverage benefits for the cost of providing the
3 21 following:
3 22 a. Marital, family, educational, developmental, or
3 23 training services.
3 24 b. Care that is substantially custodial in nature.
3 25 c. Services and supplies that are not medically necessary
3 26 or clinically appropriate.
3 27 d. Experimental treatments.
3 28 9. This section applies to third-party payment provider
3 29 policies or contracts and plans established pursuant to
3 30 chapter 509A delivered, issued for delivery, continued, or
3 31 renewed in this state on or after January 1, 2002.
3 32 Sec. 2. INSURANCE DIVISION STUDY.
3 33 1. The insurance division of the department of commerce
3 34 shall conduct a study to determine the impact of providing
3 35 coverage for substance abuse. The division shall include in
4 1 the study all of the following:
4 2 a. An estimate of the impact of mandated coverage for
4 3 substance abuse treatment on health care coverage benefit
4 4 costs.
4 5 b. Actions taken by the division to ensure that third-
4 6 party payors subject to this Act are in compliance, and that
4 7 the quality of and access to treatment for substance abuse are
4 8 not compromised by providing for coverage parity with other
4 9 coverage benefits provided for other health or medical
4 10 conditions under third-party payor contracts or policies.
4 11 c. An analysis and comparison of the choices for treatment
4 12 of substance abuse with regard to level of access, choice, and
4 13 financial burden on the individual.
4 14 d. Identification of any segments of the population of
4 15 this state that may be excluded from, or have limited access
4 16 to, treatment for substance abuse, including the number of
4 17 citizens that may be excluded from, or have limited access to,
4 18 treatment under third-party payor policies or contracts
4 19 provided by employers who receive substantial revenue from
4 20 public sources.
4 21 2. The insurance division shall submit a written report to
4 22 the general assembly on or before January 15, 2002.
4 23 EXPLANATION
4 24 This bill creates a new Code section 514C.21 and provides
4 25 that a group policy or contract providing for third-party
4 26 payment or prepayment of health or medical expenses issued by
4 27 a carrier, as defined in Code section 513B.2, or by an
4 28 organized delivery system authorized under 1993 Iowa Acts,
4 29 chapter 158, shall provide coverage benefits for treatment of
4 30 a neurobiological disorder if the policy or contract is issued
4 31 to an employer who on at least 50 percent of the employer's
4 32 working days during the preceding calendar year employed more
4 33 than 50 full-time equivalent employees; if the policy or
4 34 contract is issued to a small employer as defined in Code
4 35 section 513B.2, and such policy or contract provides coverage
5 1 benefits for the treatment of mental illness; or if the plan
5 2 is established pursuant to Code chapter 509A for public
5 3 employees.
5 4 The bill defines "neurobiological disorder" as
5 5 schizophrenia and other psychotic disorders, mood disorders,
5 6 anxiety disorders, pervasive developmental disorders, and
5 7 attention deficit. The commissioner is directed to establish
5 8 by rule the definition of the neurobiological disorders
5 9 identified. The definitions established by the commissioner
5 10 are to be consistent with definitions provided in the most
5 11 recent edition of the American psychiatric association's
5 12 diagnostic and statistical manual of mental disorders, as such
5 13 definitions may be amended from time to time. The
5 14 commissioner may adopt the definitions provided in such manual
5 15 by reference.
5 16 "Substance abuse" is defined as a pattern of pathological
5 17 use of alcohol or a drug that causes impairment in social or
5 18 occupational functioning, or that produces physiological
5 19 dependency evidenced by physical tolerance or by physical
5 20 symptoms when the alcohol or drug is withdrawn.
5 21 The bill provides that a carrier, organized delivery
5 22 system, or plan established pursuant to Code chapter 509A may
5 23 manage the benefits provided through common methods including,
5 24 but not limited to, providing payment of benefits or providing
5 25 care and treatment under a capitated payment system,
5 26 prospective reimbursement rate system, utilization control
5 27 system, incentive system for the use of least restrictive and
5 28 least costly levels of care, a preferred provider contract
5 29 limiting choice of specific providers, or any other system,
5 30 method, or organization designed to assure services are
5 31 medically necessary and clinically appropriate.
5 32 The bill provides that the new Code section created applies
5 33 to third-party payment provider contracts or policies and
5 34 public employer plans delivered, issued for delivery,
5 35 continued, or renewed in this state on or after January 1,
6 1 2002.
6 2 The bill also provides that the insurance division of the
6 3 department of commerce is to conduct a study to determine the
6 4 impact of providing substance abuse coverage, including an
6 5 estimate of the impact of substance abuse coverage on health
6 6 care coverage benefit costs; actions taken by the division to
6 7 ensure that third-party payors subject to the bill are in
6 8 compliance, and that the quality of and access to treatment
6 9 for substance abuse are not compromised by providing for
6 10 coverage parity with other coverage benefits provided for
6 11 other health or medical conditions under third-party payor
6 12 contracts or policies; an analysis and comparison of the
6 13 choices for treatment of substance abuse provided with regard
6 14 to level of access, choice, and financial burden on the
6 15 individual; and identification of any segments of the
6 16 population of this state that may be excluded from, or have
6 17 limited access to, treatment for substance abuse, including
6 18 the number of citizens that may be excluded from, or have
6 19 limited access to, treatment under third-party payor policies
6 20 or contracts provided by employers who receive substantial
6 21 revenue from public sources. The report is to be provided to
6 22 the general assembly on or before January 15, 2002.
6 23 LSB 1278HH 79
6 24 jj/pj/5
Text: HF00106 Text: HF00108 Text: HF00100 - HF00199 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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