Text: S03671 Text: S03673 Text: S03600 - S03699 Text: S Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend House File 755, as amended, passed, and
1 2 reprinted by the House, as follows:
1 3 #1. Page 28, by inserting after line 19, the
1 4 following:
1 5 "DIVISION __
1 6 HEALTH COVERAGE COSTS – MENTAL HEALTH AND
1 7 SUBSTANCE ABUSE TREATMENT
1 8 Sec. . NEW SECTION. 514C.21 MENTAL HEALTH AND
1 9 SUBSTANCE ABUSE TREATMENT COVERAGE.
1 10 1. Notwithstanding the uniformity of treatment
1 11 requirements of section 514C.6, a group policy or
1 12 contract providing for third-party payment or
1 13 prepayment of health or medical expenses shall provide
1 14 mental health and substance abuse treatment coverage
1 15 benefits and shall not impose limitations on financial
1 16 terms for coverage of services for serious mental
1 17 illnesses or substance abuse if similar limitations
1 18 are not imposed on the coverage benefits for services
1 19 for medical or surgical conditions.
1 20 2. For purposes of this section, unless the
1 21 context otherwise requires:
1 22 a. "Serious mental illness" means the following
1 23 disorders, as defined by the American psychiatric
1 24 association's diagnostic and statistical manual of
1 25 mental disorders:
1 26 (1) Schizophrenia.
1 27 (2) Schizo-affective disorder.
1 28 (3) Bipolar disorder.
1 29 (4) Major depressive disorder.
1 30 (5) Obsessive-compulsive disorder.
1 31 (6) Autism.
1 32 (7) Pervasive developmental disorders.
1 33 (8) Anxiety disorders.
1 34 (9) Paranoia and other psychotic disorders.
1 35 (10) Eating disorders, including but not limited
1 36 to bulimia nervosa and anorexia nervosa.
1 37 b. "Substance abuse" means a pattern of
1 38 pathological use of alcohol or a drug that causes
1 39 impairment in social or occupational functioning, or
1 40 that produces physiological dependency evidenced by
1 41 physical tolerance or by physical symptoms when the
1 42 alcohol or drug is withdrawn.
1 43 3. This section shall not apply to accident-only,
1 44 specific disease, short-term hospital or medical,
1 45 hospital confinement indemnity, credit, dental,
1 46 vision, Medicare supplement, long-term care, basic
1 47 hospital and medical-surgical expense coverage as
1 48 defined by the commissioner, disability income
1 49 insurance coverage, coverage issued as a supplement to
1 50 liability insurance, workers' compensation or similar
2 1 insurance, automobile medical payment insurance, or
2 2 individual accident or sickness policies issued
2 3 pursuant to chapter 513C.
2 4 4. A third-party payor may manage the benefits
2 5 provided through common methods including, but not
2 6 limited to, providing payment of benefits or providing
2 7 care and treatment under a capitated payment system,
2 8 prospective reimbursement rate system, utilization
2 9 control system, incentive system for the use of least
2 10 restrictive and least costly levels of care, a
2 11 preferred provider contract limiting choice of
2 12 specific provider, or any other system, method, or
2 13 organization designed to ensure services are medically
2 14 necessary and clinically appropriate.
2 15 5. A group policy or contract covered under this
2 16 section, at a minimum, shall provide for thirty
2 17 inpatient and sixty outpatient days annually. The
2 18 policy or contract may also include deductibles,
2 19 coinsurance, or copayments if such deductibles,
2 20 coinsurance, or copayments are applicable to other
2 21 medical or surgical services coverage under the policy
2 22 or contract. It is not a violation of this section if
2 23 the policy or contract excludes entirely from coverage
2 24 benefits the cost of providing the following:
2 25 a. Marital, family, educational, developmental, or
2 26 training services.
2 27 b. Care that is substantially custodial in nature.
2 28 c. Services and supplies that are not medically
2 29 necessary or clinically appropriate.
2 30 d. Experimental treatments.
2 31 6. The commissioner, by rule, shall increase the
2 32 mental health and substance abuse treatment lifetime
2 33 limit in the individual market guaranteed standard
2 34 product to one hundred thousand dollars.
2 35 7. A group policy is exempt from this section upon
2 36 submitting to the commissioner evidence demonstrating
2 37 a premium increase for the policy term in excess of
2 38 three percent as a result of the requirements of this
2 39 section.
2 40 8. This section applies to third-party payment
2 41 provider contracts or policies delivered, issued for
2 42 delivery, continued, or renewed in this state on or
2 43 after January 1, 2002.
2 44 9. This section is repealed effective July 1,
2 45 2004."
2 46 #2. By renumbering as necessary.
2 47
2 48
2 49
2 50 PATRICK J. DELUHERY
3 1 JOHN P. KIBBIE
3 2 MIKE CONNOLLY
3 3 JOE BOLKCOM
3 4 BILL FINK
3 5 JOHNIE HAMMOND
3 6 PATRICIA HARPER
3 7 MATT McCOY
3 8 ROBERT E. DVORSKY
3 9 MICHAEL E. GRONSTAL
3 10 BETTY A. SOUKUP
3 11 DENNIS H. BLACK
3 12 JACK HOLVECK
3 13 MARK SHEARER
3 14 THOMAS FIEGEN
3 15 STEVEN D. HANSEN
3 16 WALLY E. HORN
3 17 EUGENE S. FRAISE
3 18 HF 755.717 79
3 19 jp/cls
Text: S03671 Text: S03673 Text: S03600 - S03699 Text: S Index Bills and Amendments: General Index Bill History: General Index
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