Text: SF00130 Text: SF00132 Text: SF00100 - SF00199 Text: SF 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1 25 symptoms when the alcohol or drug is withdrawn.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 1277SS 79
4 23 jj/gg/8
Text: SF00130 Text: SF00132 Text: SF00100 - SF00199 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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