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1 1 Section 1. NEW SECTION. 514C.21 MANDATED COVERAGE FOR
1 2 NEUROBIOLOGICAL DISORDERS AND UNDERLYING CO-MORBIDITY.
1 3 1. For purposes of this section, unless the context
1 4 otherwise requires:
1 5 a. "Co-morbidity" means the coexistence of conditions or
1 6 diagnosable disorders such as neurobiological disorders and
1 7 substance abuse. For purposes of this section, "substance
1 8 abuse" means a pattern of pathological use of alcohol or a
1 9 drug that causes impairment in social or occupational
1 10 functioning, or that produces physiological dependency
1 11 evidenced by physical tolerance or by physical symptoms when
1 12 the alcohol or drug is withdrawn.
1 13 b. "Neurobiological disorder" means the following:
1 14 (1) Schizophrenia and other psychotic disorders.
1 15 (2) Affective disorders.
1 16 (3) Anxiety disorders.
1 17 (4) Pervasive developmental disorders.
1 18 (5) Attention deficit hyperactivity disorder and related
1 19 disorders.
1 20 (6) Disorders identified in childhood and adolescence.
1 21 The commissioner, by rule, shall identify the
1 22 neurobiological disorders covered by this definition,
1 23 consistent with the guidelines provided in the most recent
1 24 edition of the American psychiatric association's diagnostic
1 25 and statistical manual of mental disorders, as such
1 26 definitions may be amended from time to time. The
1 27 commissioner may adopt the definitions provided in the manual
1 28 by reference.
1 29 c. "Rates, terms, and conditions" means any lifetime or
1 30 annual payment limits, deductibles, copayments, coinsurance,
1 31 and any other cost-sharing requirements, out-of-pocket limits,
1 32 visit limitations, and any other financial component of
1 33 benefits coverage that affects the covered individual.
1 34 2. a. Notwithstanding the uniformity of treatment
1 35 requirements of section 514C.6, a policy, contract, or plan
2 1 providing for third-party payment or prepayment of health or
2 2 medical expenses shall provide coverage benefits for treatment
2 3 for neurobiological disorders and underlying co-morbidity
2 4 based on rates, terms, and conditions that are no more
2 5 restrictive than the rates, terms, and conditions for coverage
2 6 benefits provided for other health or medical conditions under
2 7 the policy, contract, or plan.
2 8 b. Any restrictions or limitations with respect to rates,
2 9 terms, and conditions involving deductibles, copayments,
2 10 coinsurance, and any other cost-sharing requirements shall be
2 11 cumulative for coverage of treatment for neurobiological
2 12 disorders and underlying co-morbidity and other health or
2 13 medical conditions under a policy, contract, or plan. A
2 14 policy, contract, or plan subject to this section shall not
2 15 impose an aggregate lifetime or annual limit on treatment for
2 16 neurobiological disorders and underlying co-morbidity coverage
2 17 benefits unless the policy, contract, or plan imposes an
2 18 aggregate lifetime or annual limit on substantially all health
2 19 or medical coverage benefits. A policy, contract, or plan
2 20 subject to this section that imposes an aggregate lifetime or
2 21 annual limit on substantially all medical and surgical
2 22 coverage benefits shall not impose an aggregate lifetime or
2 23 annual limit on treatment for neurobiological disorders and
2 24 underlying co-morbidity coverage benefits that is less than
2 25 the aggregate lifetime or annual limit imposed on
2 26 substantially all health or medical coverage benefits.
2 27 c. Coverage required under this section shall be for the
2 28 treatment of neurobiological disorders and underlying co-
2 29 morbidity, for services provided by a health professional
2 30 licensed under chapter 147A, 148, 150A, 152, 154B, 154C, or
2 31 154D, for services provided in a hospital, clinic, office,
2 32 community mental health center, health care facility,
2 33 outpatient treatment facility, residential treatment facility,
2 34 halfway house, or similar facility for the provision of health
2 35 care services, and for services provided pursuant to the
3 1 comprehensive program for treatment for substance abuse
3 2 maintained by the department of public health pursuant to
3 3 section 125.12 in a hospital licensed under chapter 135B or a
3 4 facility licensed under chapter 125.
3 5 3. This section applies to the following classes of third-
3 6 party payment provider policies, contracts, or plans
3 7 delivered, issued for delivery, continued, or renewed in this
3 8 state on or after January 1, 2003:
3 9 a. Individual or group accident and sickness insurance
3 10 providing coverage on an expense-incurred basis.
3 11 b. An individual or group hospital or medical service
3 12 contract issued pursuant to chapter 509, 514, or 514A.
3 13 c. A plan established pursuant to chapter 509A for public
3 14 employees.
3 15 d. An individual or group health maintenance organization
3 16 contract regulated under chapter 514B.
3 17 e. An individual or group Medicare supplemental policy,
3 18 unless coverage pursuant to such policy is preempted by
3 19 federal law.
3 20 f. Any other entity engaged in the business of insurance,
3 21 risk transfer, or risk retention, which is subject to the
3 22 jurisdiction of the commissioner.
3 23 g. An organized delivery system licensed by the director
3 24 of public health.
3 25 4. The commissioner shall adopt rules pursuant to chapter
3 26 17A to administer this section.
3 27 Sec. 2. INSURANCE DIVISION STUDY IN CONJUNCTION WITH STATE
3 28 AUDITOR.
3 29 1. The insurance division of the department of commerce,
3 30 in conjunction with the state auditor, shall conduct a study
3 31 of the cost of providing neurobiological disorder coverage
3 32 benefits in Iowa.
3 33 2. The study shall assess at least all of the following:
3 34 a. Identification of the costs attributed to treatment of
3 35 neurobiological disorders, and to underlying co-morbidity.
4 1 b. An estimate of the impact of mandated coverage on
4 2 health care coverage benefit costs and availability.
4 3 c. Actions taken by the division to ensure that third-
4 4 party payors subject to this Act are in compliance.
4 5 d. Identification of any segments of the population of
4 6 this state that may be excluded from, or have limited access
4 7 to, treatment, including the number of citizens that may be
4 8 excluded from, or have limited access to, treatment under
4 9 third-party payor policies or contracts provided by employers
4 10 who receive substantial revenue from public sources.
4 11 3. The insurance division shall submit a written report to
4 12 the general assembly on or before January 30, 2005.
4 13 Sec. 3. DEPARTMENT OF PUBLIC HEALTH STUDY.
4 14 1. The department of public health shall conduct a two-
4 15 year study of the mental health delivery system in Iowa,
4 16 beginning July 1, 2002.
4 17 2. The study shall include participation by at least all
4 18 of the following:
4 19 a. Representatives of professional health care groups
4 20 licensed under chapters 147A, 148, 150A, 152, 154B, 154C, and
4 21 154D.
4 22 b. Representatives of associations or other groups
4 23 representing hospitals, clinics, community mental health
4 24 centers, community corrections and prison corrections, health
4 25 care facilities, outpatient treatment facilities, and any
4 26 other facility offering mental health services.
4 27 c. County supervisors, representatives from the department
4 28 of human services, judges, mental health advocates, and other
4 29 state or county officials involved in the provision of mental
4 30 health services.
4 31 d. Consumers, family members, and patients.
4 32 3. The participants in the study shall assess the relevant
4 33 issues facing the mental health delivery system in Iowa, and
4 34 shall prepare a report with recommendations for presentation
4 35 to the general assembly no later than November 1, 2004.
5 1 EXPLANATION
5 2 This bill creates new Code section 514C.21 and provides
5 3 that a policy, contract, or plan providing for third-party
5 4 payment or prepayment of health or medical expenses must
5 5 provide coverage benefits for neurobiological disorders and
5 6 underlying co-morbidity based on rates, terms, and conditions
5 7 that are no more restrictive than the rates, terms, and
5 8 conditions associated with coverage benefits provided for
5 9 other conditions under the policy, contract, or plan.
5 10 The bill requires a joint study by the insurance division
5 11 and state auditor regarding the costs of providing
5 12 neurobiological disorder coverage benefits to be submitted to
5 13 the general assembly by January 30, 2005. The bill also
5 14 requires a two-year study of the mental health delivery system
5 15 coordinated by the department of public health, for
5 16 presentation to the general assembly by November 1, 2004.
5 17 LSB 6583SV 79
5 18 jj/sh/8
Text: SF02288 Text: SF02290 Text: SF02200 - SF02299 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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