Text: SSB03079                          Text: SSB03081
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Senate Study Bill 3080

Bill Text

PAG LIN
  1  1    Section 1.  NEW SECTION.  514C.21  MANDATED COVERAGE FOR
  1  2 MENTAL HEALTH CONDITIONS AND SUBSTANCE ABUSE TREATMENT
  1  3 SERVICES.
  1  4    1.  For purposes of this section, unless the context
  1  5 otherwise requires:
  1  6    a.  "Mental health condition" means a condition or disorder
  1  7 involving mental illness that is listed in the most recent
  1  8 edition of the American psychiatric association's diagnostic
  1  9 and statistical manual of mental disorders, as periodically
  1 10 revised.
  1 11    b.  "Rates, terms, and conditions" means any lifetime or
  1 12 annual payment limits, deductibles, copayments, coinsurance,
  1 13 and any other cost-sharing requirements, out-of-pocket limits,
  1 14 visit limitations, and any other financial component of
  1 15 benefits coverage that affects the covered individual.
  1 16    c.  "Substance abuse" means a pattern of pathological use
  1 17 of alcohol or a drug that causes impairment in social or
  1 18 occupational functioning, or that produces physiological
  1 19 dependency evidenced by physical tolerance or by physical
  1 20 symptoms when the alcohol or drug is withdrawn.
  1 21    2.  a.  Notwithstanding the uniformity of treatment
  1 22 requirements of section 514C.6, a policy, contract, or plan
  1 23 providing for third-party payment or prepayment of health or
  1 24 medical expenses shall provide coverage benefits for mental
  1 25 health conditions and substance abuse treatment services based
  1 26 on rates, terms, and conditions that are no more restrictive
  1 27 than the rates, terms, and conditions for coverage benefits
  1 28 provided for other health or medical conditions under the
  1 29 policy, contract, or plan.
  1 30    b.  Any restrictions or limitations with respect to rates,
  1 31 terms, and conditions involving deductibles, copayments,
  1 32 coinsurance, and any other cost-sharing requirements shall be
  1 33 cumulative for coverage of mental health conditions, substance
  1 34 abuse treatment services, and other health or medical
  1 35 conditions under a policy, contract, or plan.  A policy,
  2  1 contract, or plan subject to this section shall not impose an
  2  2 aggregate lifetime or annual limit on mental health conditions
  2  3 or substance abuse treatment services coverage benefits unless
  2  4 the policy, contract, or plan imposes an aggregate lifetime or
  2  5 annual limit on substantially all health or medical coverage
  2  6 benefits.  A policy, contract, or plan subject to this section
  2  7 that imposes an aggregate lifetime or annual limit on
  2  8 substantially all medical and surgical coverage benefits shall
  2  9 not impose an aggregate lifetime or annual limit on mental
  2 10 health condition or substance abuse treatment services
  2 11 coverage benefits that is less than the aggregate lifetime or
  2 12 annual limit imposed on substantially all health or medical
  2 13 coverage benefits.
  2 14    c.  Coverage required under this section shall be as
  2 15 follows:
  2 16    (1)  For the treatment of a mental health condition,
  2 17 coverage shall be for services provided by a health
  2 18 professional licensed under chapters 147A, 148, 150A, 154B,
  2 19 154C, and 154D, and services provided in a hospital, clinic,
  2 20 office, community mental health center, health care facility,
  2 21 outpatient treatment facility, or similar facility for the
  2 22 provision of health care services.
  2 23    (2)  For the treatment of substance abuse, coverage shall
  2 24 be for emergency treatment, outpatient treatment, inpatient
  2 25 treatment, residential treatment, halfway house treatment, and
  2 26 follow-up treatment and rehabilitation, pursuant to the
  2 27 comprehensive program for treatment for substance abuse
  2 28 maintained by the department of public health pursuant to
  2 29 section 125.12 in hospitals licensed under chapter 135B and
  2 30 facilities licensed under chapter 125.
  2 31    3.  This section applies to the following classes of third-
  2 32 party payment provider policies, contracts, or plans
  2 33 delivered, issued for delivery, continued, or renewed in this
  2 34 state on or after January 1, 2003:
  2 35    a.  Individual or group accident and sickness insurance
  3  1 providing coverage on an expense-incurred basis.
  3  2    b.  An individual or group hospital or medical service
  3  3 contract issued pursuant to chapter 509, 514, or 514A.
  3  4    c.  A plan established pursuant to chapter 509A for public
  3  5 employees.
  3  6    d.  An individual or group health maintenance organization
  3  7 contract regulated under chapter 514B.
  3  8    e.  An individual or group Medicare supplemental policy,
  3  9 unless coverage pursuant to such policy is preempted by
  3 10 federal law.
  3 11    f.  Any other entity engaged in the business of insurance,
  3 12 risk transfer, or risk retention, which is subject to the
  3 13 jurisdiction of the commissioner.
  3 14    g.  An organized delivery system licensed by the director
  3 15 of public health.
  3 16    4.  The commissioner shall adopt rules pursuant to chapter
  3 17 17A to administer this section.  
  3 18                           EXPLANATION
  3 19    This bill creates new Code section 514C.21 and provides
  3 20 that a policy, contract, or plan providing for third-party
  3 21 payment or prepayment of health or medical expenses must
  3 22 provide coverage benefits for mental health conditions and
  3 23 substance abuse treatment services based on rates, terms, and
  3 24 conditions that are no more restrictive than the rates, terms,
  3 25 and conditions associated with coverage benefits provided for
  3 26 other conditions under the policy, contract, or plan.
  3 27    "Mental health condition" is defined to mean a condition or
  3 28 disorder involving mental illness that is listed in the
  3 29 American psychiatric association's diagnostic and statistical
  3 30 manual of mental disorders.  "Substance abuse" means a pattern
  3 31 of pathological use of alcohol or a drug that causes
  3 32 impairment or produces dependency.  
  3 33 LSB 6583SC 79
  3 34 jj/sh/8 
     

Text: SSB03079                          Text: SSB03081
Text: SSB03000 - SSB03099               Text: SSB Index
Bills and Amendments: General Index     Bill History: General Index

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