Text: HF00112 Text: HF00114 Text: HF00100 - HF00199 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. NEW SECTION. 509A.6A NEUROBIOLOGICAL DISORDER 1 2 AND SUBSTANCE ABUSE COVERAGE FOR STATE EMPLOYEES. 1 3 1. A state health or medical group insurance plan for 1 4 state employees shall provide coverage benefits for treatment 1 5 services for neurobiological disorders and substance abuse 1 6 which shall be on terms and conditions which are no more 1 7 restrictive than the terms and conditions for coverage 1 8 benefits provided for other medical conditions under such 1 9 plan. 1 10 2. For purposes of this section: 1 11 a. "Neurobiological disorder" means the following: 1 12 (1) Schizophrenia and other psychotic disorders. 1 13 (2) Mood disorders. 1 14 (3) Anxiety disorders. 1 15 (4) Pervasive development disorders and attention deficit. 1 16 b. "State employee" means a person who is a paid employee 1 17 of the state of Iowa, including a paid employee of the state 1 18 board of regents. 1 19 c. "State health or medical group insurance plan" means as 1 20 defined in section 509A.13A. 1 21 d. "Substance abuse" means a pattern of pathological use 1 22 of alcohol or a drug that causes impairment in social or 1 23 occupational functioning, or that produces physiological 1 24 dependency evidenced by physical tolerance or by physical 1 25 symptoms when the alcohol or drug is withdrawn. 1 26 3. The commissioner, by rule, shall define the 1 27 biologically based mental illnesses identified in subsection 1 28 2. Definitions established by the commissioner shall be 1 29 consistent with definitions provided in the most recent 1 30 edition of the American psychiatric association's diagnostic 1 31 and statistical manual of mental disorders, as such 1 32 definitions may be amended from time to time. The 1 33 commissioner may adopt the definitions provided in such manual 1 34 by reference. 1 35 4. This section shall not apply to accident only, 2 1 specified disease, short-term hospital or medical, hospital 2 2 confinement indemnity, credit, dental, vision, Medicare 2 3 supplement, long-term care, basic hospital and medical- 2 4 surgical expense coverage as defined by the commissioner, 2 5 disability income insurance coverage, coverage issued as a 2 6 supplement to liability insurance, workers' compensation or 2 7 similar insurance, or automobile medical payment insurance, or 2 8 individual accident and sickness policies issued to 2 9 individuals or to individual members of a member association. 2 10 5. A carrier, organized delivery system, or plan may 2 11 manage the benefits provided under this section provided 2 12 through common methods including, but not limited to, 2 13 providing payment of benefits or providing care and treatment 2 14 under a capitated payment system, prospective reimbursement 2 15 rate system, utilization control system, incentive system for 2 16 the use of least restrictive and least costly levels of care, 2 17 a preferred provider contract limiting choice of specific 2 18 providers, or any other system, method, or organization 2 19 designed to ensure that services are medically necessary and 2 20 clinically appropriate. 2 21 6. a. A plan covered under this section shall not impose 2 22 an aggregate annual or lifetime limit on neurobiological 2 23 disorder or substance abuse coverage benefits unless the plan 2 24 imposes an aggregate annual or lifetime limit on substantially 2 25 all medical and surgical coverage benefits. 2 26 b. A plan covered under this section that imposes an 2 27 aggregate annual or lifetime limit on substantially all 2 28 medical and surgical coverage benefits shall not impose an 2 29 aggregate annual or lifetime limit on neurobiological disorder 2 30 or substance abuse coverage benefits which is less than the 2 31 aggregate annual or lifetime limit imposed on substantially 2 32 all medical and surgical coverage benefits. 2 33 7. A plan covered under this section shall at a minimum 2 34 allow for thirty inpatient days and fifty-two outpatient 2 35 visits annually. The plan may also include deductibles, 3 1 coinsurance, or copayments, provided the amounts and extent of 3 2 such deductibles, coinsurance, or copayments applicable to 3 3 other medical or surgical services coverage under the plan are 3 4 the same. It is not a violation of this section if the plan 3 5 excludes entirely from coverage benefits for the cost of 3 6 providing the following: 3 7 a. Marital, family, educational, developmental, or 3 8 training services. 3 9 b. Care that is substantially custodial in nature. 3 10 c. Services and supplies that are not medically necessary 3 11 or clinically appropriate. 3 12 d. Experimental treatments. 3 13 8. This section applies to plans established pursuant to 3 14 this chapter delivered, issued for delivery, continued, or 3 15 renewed in this state on or after January 1, 2002. 3 16 EXPLANATION 3 17 This bill creates new Code section 509A.6A and provides 3 18 that a state health or medical group insurance plan for state 3 19 employees must provide coverage benefits for services for 3 20 clinical disorders related to neurobiological disorders and 3 21 substance abuse which are to be on terms and conditions which 3 22 are no more restrictive than the terms and conditions 3 23 associated with coverage benefits provided for other 3 24 conditions under such plan. 3 25 The bill defines "neurobiological disorder" as 3 26 schizophrenia and other psychotic disorders, mood disorders, 3 27 anxiety disorders, pervasive developmental disorders, and 3 28 attention deficit. The commissioner is directed to establish 3 29 by rule the definition of the neurobiological disorders 3 30 identified. The definitions established by the commissioner 3 31 are to be consistent with definitions provided in the most 3 32 recent edition of the American psychiatric association's 3 33 diagnostic and statistical manual of mental disorders, as such 3 34 definitions may be amended from time to time. The 3 35 commissioner may adopt the definitions provided in such manual 4 1 by reference. 4 2 "Substance abuse" is defined as a pattern of pathological 4 3 use of alcohol or a drug that causes impairment in social or 4 4 occupational functioning, or that produces physiological 4 5 dependency evidenced by physical tolerance or by physical 4 6 symptoms when the alcohol or drug is withdrawn. 4 7 The bill provides that a carrier, organized delivery 4 8 system, or plan may manage the benefits provided under Code 4 9 section 509A.6A through common methods including, but not 4 10 limited to, providing payment of benefits or providing care 4 11 and treatment under a capitated payment system, prospective 4 12 reimbursement rate system, utilization control system, 4 13 incentive system for the use of least restrictive and least 4 14 costly levels of care, a preferred provider contract limiting 4 15 choice of specific providers, or any other system, method, or 4 16 organization designed to assure services are medically 4 17 necessary and clinically appropriate. 4 18 The bill provides that the new Code section created applies 4 19 to public employer plans delivered, issued for delivery, 4 20 continued, or renewed in this state on or after January 1, 4 21 2002. 4 22 LSB 1277HH 79 4 23 jj/gg/8
Text: HF00112 Text: HF00114 Text: HF00100 - HF00199 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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