Text: SF02228 Text: SF02230 Text: SF02200 - SF02299 Text: SF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. Section 135H.12, Code 2001, is amended by 1 2 adding the following new subsection: 1 3 NEW SUBSECTION. 3. The department is designated as the 1 4 sole agency for performing inspections, interviews, or other 1 5 investigation activities, or for making other responses to 1 6 address a complaint made under this chapter or any other law 1 7 regarding a psychiatric institution or a person employed by a 1 8 psychiatric institution. Notwithstanding any other law to the 1 9 contrary, upon completion of an inspection, interview, or 1 10 other investigation activity in response to a complaint, the 1 11 department may disclose any information obtained to the 1 12 department of human services, a designated protection and 1 13 advocacy agency, or a regulatory agency that would otherwise 1 14 perform a similar inspection, interview, or investigation 1 15 activity in response to a complaint involving a psychiatric 1 16 institution. The department shall cooperate with a law 1 17 enforcement agency's investigation of a criminal complaint 1 18 involving a psychiatric institution. 1 19 Sec. 2. Section 509.3, Code 2001, is amended by adding the 1 20 following new subsection: 1 21 NEW SUBSECTION. 8. A provision shall be made available to 1 22 policyholders, under group policies covering behavioral health 1 23 care, for payment of necessary behavioral health care provided 1 24 by a psychiatric medical institution for children licensed 1 25 under chapter 135H if the behavioral health care is provided 1 26 within the scope of a psychiatric medical institution for 1 27 children's license and if the policy would pay for the 1 28 behavioral health care if the behavioral health care were 1 29 provided by a hospital or other inpatient provider of 1 30 behavioral health care. The policy shall also provide that 1 31 the policyholder may reject the coverage or provision if the 1 32 coverage or provision for behavioral health care that may be 1 33 provided by a psychiatric medical institution for children is 1 34 rejected for all providers of similar behavioral health care. 1 35 This paragraph applies to group policies delivered on or after 2 1 July 1, 2002, and to existing group policies on their next 2 2 anniversary or renewal dates, or upon expiration of the 2 3 applicable collective bargaining contract, if any, whichever 2 4 is later. This subsection does not apply to blanket, short- 2 5 term travel, accident-only, limited or specified disease, or 2 6 individual or group conversion policies, policies rated on a 2 7 community basis, or policies designed only for issuance to 2 8 persons for eligible coverage under Title XVIII of the federal 2 9 Social Security Act, or any other similar coverage under a 2 10 state or federal government plan. 2 11 Sec. 3. Section 514.7, Code 2001, is amended by adding the 2 12 following new unnumbered paragraph: 2 13 NEW UNNUMBERED PARAGRAPH. A provision shall be available 2 14 in approved contracts with hospital and medical service 2 15 corporate subscribers under group subscriber contracts or 2 16 plans covering behavioral health care, for payment of 2 17 necessary behavioral health care provided by a psychiatric 2 18 medical institution for children licensed under chapter 135H, 2 19 if the behavioral health care is provided within the scope of 2 20 a psychiatric medical institution for children's license and 2 21 if the subscriber contract would pay for the behavioral health 2 22 care if the behavioral health care were provided by a hospital 2 23 or other inpatient provider of behavioral health care. The 2 24 subscriber contract shall also provide that the subscriber may 2 25 reject the coverage or provision if the coverage or provision 2 26 for behavioral health care that may be provided by a 2 27 psychiatric medical institution for children is rejected for 2 28 all providers of similar behavioral health care. This 2 29 paragraph applies to group subscriber contracts delivered on 2 30 or after July 1, 2002, and to group subscriber contracts on 2 31 their anniversary or renewal date, or upon the expiration of 2 32 the applicable collective bargaining contract, if any, 2 33 whichever is the later. This paragraph does not apply to 2 34 contracts designed only for issuance to subscribers eligible 2 35 for coverage under Title XVIII of the federal Social Security 3 1 Act, or any other similar coverage under a state or federal 3 2 government plan. 3 3 Sec. 4. Section 514B.1, subsection 5, Code 2001, is 3 4 amended by adding the following new paragraph: 3 5 NEW PARAGRAPH. e. The health care services available to 3 6 enrollees under prepaid group plans covering behavioral health 3 7 care, shall include a provision for payment of necessary 3 8 behavioral health care provided by a psychiatric medical 3 9 institution for children licensed under chapter 135H, if the 3 10 behavioral health care is provided within the scope of a 3 11 psychiatric medical institution for children's license and if 3 12 the subscriber contract would pay for the behavioral health 3 13 care if the behavioral health care were provided by a hospital 3 14 or other inpatient provider of behavioral health care. The 3 15 plan shall also provide that the plan enrollees may reject the 3 16 coverage or provision if the coverage or provision for 3 17 behavioral health care that may be provided by a psychiatric 3 18 medical institution for children is rejected for all providers 3 19 of similar behavioral health care. This paragraph applies to 3 20 prepaid group plans made on or after July 1, 2002, and to 3 21 existing group plans on their next anniversary or renewal 3 22 date, or upon the expiration of the applicable collective 3 23 bargaining contract, if any, whichever is the later. This 3 24 paragraph does not apply to contracts designed only for 3 25 issuance to enrollees eligible for coverage under Title XVIII 3 26 of the federal Social Security Act, or any other similar 3 27 coverage under a state or federal government plan. 3 28 EXPLANATION 3 29 This bill relates to psychiatric medical institutions for 3 30 children (PMIC) requirements involving complaint response and 3 31 behavioral health care coverage. 3 32 Code section 135H.12, relating to the duties of the 3 33 department of inspections and appeals in response to a 3 34 complaint concerning a PMIC, is amended. The department is 3 35 designated as the sole agency for responding to complaints 4 1 under the PMIC Code chapter and for other complaints involving 4 2 a PMIC or PMIC employee. Notwithstanding any other law, the 4 3 department of inspections and appeals may disclose to certain 4 4 entities any information obtained in performing inspections, 4 5 interviews, or other investigation activities, or for making 4 6 other responses to address a complaint. The disclosure may be 4 7 made to the department of human services, a designated 4 8 protection and advocacy agency, or other regulatory agency 4 9 that would otherwise perform a similar inspection, interview, 4 10 or investigation activity in response to a complaint involving 4 11 a psychiatric institution. The department is required to 4 12 cooperate with a law enforcement agency's investigation of a 4 13 criminal complaint involving a PMIC. 4 14 The bill amends Code section 509.3, relating to group 4 15 insurance provisions as part of an accident or health policy. 4 16 The bill requires that a provision be offered to policyholders 4 17 for payment for behavioral health care provided within the 4 18 scope of a PMIC license that would be paid for in a hospital 4 19 or if provided by another inpatient provider of behavioral 4 20 health care. An exception to the requirement is made for 4 21 various types of short-term and other policies subject to some 4 22 form of limitation. 4 23 Code section 514.7, relating to nonprofit health service 4 24 corporation contracts, is similarly amended to apply the PMIC 4 25 payment requirement to such contracts. 4 26 Code section 514B.1, relating to definitions for health 4 27 maintenance organization plans, is similarly amended to apply 4 28 the PMIC payment requirement to such plans. 4 29 The three health coverage provisions are applicable to 4 30 policies or contracts delivered or plans made on or after July 4 31 1, 2002, and to existing policies, contracts, or plans after 4 32 that date. 4 33 LSB 6033SV 79 4 34 jp/pj/5
Text: SF02228 Text: SF02230 Text: SF02200 - SF02299 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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