Text: SF02288 Text: SF02290 Text: SF02200 - SF02299 Text: SF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 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physiological dependency 1 11 evidenced by physical tolerance or by physical symptoms when 1 12 the alcohol or drug is withdrawn. 1 13 b. "Neurobiological disorder" means the following: 1 14 (1) Schizophrenia and other psychotic disorders. 1 15 (2) Affective disorders. 1 16 (3) Anxiety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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