House Journal: Page 1369: Thursday, April 11, 2002
26 neurobiological disorder identified in subsection 2.
27 Definitions established by the commissioner shall be
28 consistent with definitions provided in the most
29 recent edition of the American psychiatric
30 association's diagnostic and statistical manual of
31 mental disorders, as such definitions may be amended
32 from time to time. The commissioner may adopt the
33 definitions provided in such manual by reference.
34 4. This section shall not apply to accident only,
35 specified disease, short-term hospital or medical,
36 hospital confinement indemnity, credit, dental,
37 vision, Medicare supplement, long-term care, basic
38 hospital and medical-surgical expense coverage as
39 defined by the commissioner, disability income
40 insurance coverage, coverage issued as a supplement to
41 liability insurance, workers' compensation or similar
42 insurance, or automobile medical payment insurance, or
43 individual accident and sickness policies issued to
44 individuals or to individual members of a member
45 association.
46 5. A carrier, organized delivery system, or plan
47 may manage the benefits provided under this section
48 provided through common methods including, but not
49 limited to, providing payment of benefits or providing
50 care and treatment under a capitated payment system,
Page 2
1 prospective reimbursement rate system, utilization
2 control system, incentive system for the use of least
3 restrictive and least costly levels of care, a
4 preferred provider contract limiting choice of
5 specific providers, or any other system, method, or
6 organization designed to ensure that services are
7 medically necessary and clinically appropriate.
8 6. a. A plan covered under this section shall not
9 impose an aggregate annual or lifetime limit on
10 neurobiological disorder coverage benefits unless the
11 plan imposes an aggregate annual or lifetime limit on
12 substantially all medical and surgical coverage
13 benefits.
14 b. A plan covered under this section that imposes
15 an aggregate annual or lifetime limit on substantially
16 all medical and surgical coverage benefits shall not
17 impose an aggregate annual or lifetime limit on
18 neurobiological disorder coverage benefits which is
19 less than the aggregate annual or lifetime limit
20 imposed on substantially all medical and surgical
21 coverage benefits.
22 7. A plan covered under this section shall at a
23 minimum allow for thirty inpatient days and fifty-two
24 outpatient visits annually. The plan may also include
© 2002 Cornell College and
League of Women Voters of Iowa
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