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physiological dependency 1 16 evidenced by physical tolerance or by physical 1 17 symptoms when the alcohol or drug is withdrawn. 1 18 b. "Neurobiological disorder" means the following: 1 19 (1) Schizophrenia and other psychotic disorders. 1 20 (2) Affective disorders. 1 21 (3) Anxiety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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