Text: S05274 Text: S05276 Text: S05200 - S05299 Text: S Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend Senate File 2322 as follows:
1 2 #1. By striking everything after the enacting
1 3 clause and inserting the following:
1 4 "Section 1. NEW SECTION. 514C.21 MANDATED
1 5 COVERAGE FOR NEUROBIOLOGICAL DISORDERS AND UNDERLYING
1 6 CO-MORBIDITY.
1 7 1. For purposes of this section, unless the
1 8 context otherwise requires:
1 9 a. "Co-morbidity" means the coexistence of
1 10 conditions or diagnosable disorders such as
1 11 neurobiological disorders and substance abuse. For
1 12 purposes of this section, "substance abuse" means a
1 13 pattern of pathological use of alcohol or a drug that
1 14 causes impairment in social or occupational
1 15 functioning, or that produces physiological dependency
1 16 evidenced by physical tolerance or by physical
1 17 symptoms when the alcohol or drug is withdrawn.
1 18 b. "Neurobiological disorder" means the following:
1 19 (1) Schizophrenia and other psychotic disorders.
1 20 (2) Affective disorders.
1 21 (3) Anxiety disorders.
1 22 (4) Pervasive developmental disorders.
1 23 (5) Attention deficit hyperactivity disorder and
1 24 related disorders.
1 25 (6) Disorders identified in childhood and
1 26 adolescence.
1 27 The commissioner, by rule, shall identify the
1 28 neurobiological disorders covered by this definition,
1 29 consistent with the guidelines provided in the most
1 30 recent edition of the American psychiatric
1 31 association's diagnostic and statistical manual of
1 32 mental disorders, as such definitions may be amended
1 33 from time to time. The commissioner may adopt the
1 34 definitions provided in the manual by reference.
1 35 c. "Rates, terms, and conditions" means any
1 36 lifetime or annual payment limits, deductibles,
1 37 copayments, coinsurance, and any other cost-sharing
1 38 requirements, out-of-pocket limits, visit limitations,
1 39 and any other financial component of benefits coverage
1 40 that affects the covered individual.
1 41 2. a. Notwithstanding the uniformity of treatment
1 42 requirements of section 514C.6, a policy, contract, or
1 43 plan providing for third-party payment or prepayment
1 44 of health or medical expenses shall provide coverage
1 45 benefits for treatment for neurobiological disorders
1 46 and underlying co-morbidity based on rates, terms, and
1 47 conditions that are no more restrictive than the
1 48 rates, terms, and conditions for coverage benefits
1 49 provided for other health or medical conditions under
1 50 the policy, contract, or plan.
2 1 b. Any restrictions or limitations with respect to
2 2 rates, terms, and conditions involving deductibles,
2 3 copayments, coinsurance, and any other cost-sharing
2 4 requirements shall be cumulative for coverage of
2 5 treatment for neurobiological disorders and underlying
2 6 co-morbidity and other health or medical conditions
2 7 under a policy, contract, or plan. A policy,
2 8 contract, or plan subject to this section shall not
2 9 impose an aggregate lifetime or annual limit on
2 10 treatment for neurobiological disorders and underlying
2 11 co-morbidity coverage benefits unless the policy,
2 12 contract, or plan imposes an aggregate lifetime or
2 13 annual limit on substantially all health or medical
2 14 coverage benefits. A policy, contract, or plan
2 15 subject to this section that imposes an aggregate
2 16 lifetime or annual limit on substantially all medical
2 17 and surgical coverage benefits shall not impose an
2 18 aggregate lifetime or annual limit on treatment for
2 19 neurobiological disorders and underlying co-morbidity
2 20 coverage benefits that is less than the aggregate
2 21 lifetime or annual limit imposed on substantially all
2 22 health or medical coverage benefits.
2 23 c. Coverage required under this section shall be
2 24 for the treatment of neurobiological disorders and
2 25 underlying co-morbidity, for services provided by a
2 26 health professional licensed under chapter 147A, 148,
2 27 150A, 152, 154B, 154C, or 154D, for services provided
2 28 in a hospital, clinic, office, community mental health
2 29 center, health care facility, outpatient treatment
2 30 facility, residential treatment facility, halfway
2 31 house, or similar facility for the provision of health
2 32 care services, and for services provided pursuant to
2 33 the comprehensive program for treatment for substance
2 34 abuse maintained by the department of public health
2 35 pursuant to section 125.12 in a hospital licensed
2 36 under chapter 135B or a facility licensed under
2 37 chapter 125.
2 38 3. This section applies to the following classes
2 39 of third-party payment provider policies, contracts,
2 40 or plans delivered, issued for delivery, continued, or
2 41 renewed in this state on or after January 1, 2003:
2 42 a. Individual or group accident and sickness
2 43 insurance providing coverage on an expense-incurred
2 44 basis.
2 45 b. An individual or group hospital or medical
2 46 service contract issued pursuant to chapter 509, 514,
2 47 or 514A.
2 48 c. A plan established pursuant to chapter 509A for
2 49 public employees.
2 50 d. An individual or group health maintenance
3 1 organization contract regulated under chapter 514B.
3 2 e. An individual or group Medicare supplemental
3 3 policy, unless coverage pursuant to such policy is
3 4 preempted by federal law.
3 5 f. Any other entity engaged in the business of
3 6 insurance, risk transfer, or risk retention, which is
3 7 subject to the jurisdiction of the commissioner.
3 8 g. An organized delivery system licensed by the
3 9 director of public health.
3 10 4. The commissioner shall adopt rules pursuant to
3 11 chapter 17A to administer this section.
3 12 Sec. 2. INSURANCE DIVISION STUDY IN CONJUNCTION
3 13 WITH STATE AUDITOR.
3 14 1. The insurance division of the department of
3 15 commerce, in conjunction with the state auditor, shall
3 16 conduct a study of the cost of providing
3 17 neurobiological disorder coverage benefits in Iowa.
3 18 2. The study shall assess at least all of the
3 19 following:
3 20 a. Identification of the costs attributed to
3 21 treatment of neurobiological disorders, and to
3 22 underlying co-morbidity.
3 23 b. An estimate of the impact of mandated coverage
3 24 on health care coverage benefit costs and
3 25 availability.
3 26 c. Actions taken by the division to ensure that
3 27 third-party payors subject to this Act are in
3 28 compliance.
3 29 d. Identification of any segments of the
3 30 population of this state that may be excluded from, or
3 31 have limited access to, treatment, including the
3 32 number of citizens that may be excluded from, or have
3 33 limited access to, treatment under third-party payor
3 34 policies or contracts provided by employers who
3 35 receive substantial revenue from public sources.
3 36 3. The insurance division shall submit a written
3 37 report to the general assembly on or before January
3 38 30, 2005.
3 39 Sec. 3. DEPARTMENT OF PUBLIC HEALTH STUDY.
3 40 1. The department of public health shall conduct a
3 41 two-year study of the mental health delivery system in
3 42 Iowa, beginning July 1, 2002.
3 43 2. The study shall include participation by at
3 44 least all of the following:
3 45 a. Representatives of professional health care
3 46 groups licensed under chapters 147A, 148, 150A, 152,
3 47 154B, 154C, and 154D.
3 48 b. Representatives of associations or other groups
3 49 representing hospitals, clinics, community mental
3 50 health centers, community corrections and prison
4 1 corrections, health care facilities, outpatient
4 2 treatment facilities, and any other facility offering
4 3 mental health services.
4 4 c. County supervisors, representatives from the
4 5 department of human services, judges, mental health
4 6 advocates, and other state or county officials
4 7 involved in the provision of mental health services.
4 8 d. Consumers, family members, and patients.
4 9 3. The participants in the study shall assess the
4 10 relevant issues facing the mental health delivery
4 11 system in Iowa, and shall prepare a report with
4 12 recommendations for presentation to the general
4 13 assembly no later than November 1, 2004."
4 14 #2. Title page, line 1, by striking the words "tax
4 15 credits and related".
4 16 #3. Title page, line 2, by inserting after the
4 17 word "disorders," the following: "and".
4 18 #4. Title page, lines 3 and 4, by striking the
4 19 words ", and providing applicability and effective
4 20 dates".
4 21 #5. By renumbering, redesignating, and correcting
4 22 internal references as necessary.
4 23
4 24
4 25
4 26 THOMAS FIEGEN
4 27 MIKE CONNOLLY
4 28 MATT McCOY
4 29 WALLY E. HORN
4 30 JACK HOLVECK
4 31 JOHN P. KIBBIE
4 32 JOE BOLKCOM
4 33 BILL FINK
4 34 DICK L. DEARDEN
4 35 EUGENE S. FRAISE
4 36 ROBERT E. DVORSKY
4 37 DENNIS H. BLACK
4 38 STEVEN D. HANSEN
4 39 TOM FLYNN
4 40 MARK SHEARER
4 41 PATRICIA HARPER
4 42 PATRICK J. DELUHERY
4 43 AMANDA RAGAN
4 44 JOHNIE HAMMOND
4 45 MICHAEL E. GRONSTAL
4 46 MARY A. LUNDBY
4 47 MAGGIE TINSMAN
4 48 SF 2322.301 79
4 49 jj/cf
Text: S05274 Text: S05276 Text: S05200 - S05299 Text: S Index Bills and Amendments: General Index Bill History: General Index
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