Text: S05201 Text: S05203 Text: S05200 - S05299 Text: S Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend Senate File 2298 as follows:
1 2 #1. Page 193, by inserting after line 33 the
1 3 following:
1 4 "Sec. . NEW SECTION. 514C.21 MANDATED
1 5 COVERAGE FOR MENTAL HEALTH CONDITIONS.
1 6 1. For purposes of this section, unless the
1 7 context otherwise requires:
1 8 a. "Mental health condition" means a condition or
1 9 disorder involving mental illness or alcohol or
1 10 substance abuse that falls under any of the diagnostic
1 11 categories listed in the mental disorders section of
1 12 the international classification of disease, as
1 13 periodically revised.
1 14 b. "Rates, terms, and conditions" means any
1 15 lifetime payment limits, deductibles, copayments,
1 16 coinsurance, and any other cost-sharing requirements,
1 17 out-of-pocket limits, visit limitations, and any other
1 18 financial component of benefits coverage that affects
1 19 the covered individual.
1 20 2. a. Notwithstanding section 514C.6, a policy or
1 21 contract providing for third-party payment or
1 22 prepayment of health or medical expenses shall provide
1 23 coverage benefits for mental health conditions based
1 24 on rates, terms, and conditions which are no more
1 25 restrictive than the rates, terms, and conditions for
1 26 coverage benefits provided for other health or medical
1 27 conditions under the policy or contract.
1 28 Additionally, any rates, terms, and conditions
1 29 involving deductibles, copayments, coinsurance, and
1 30 any other cost-sharing requirements shall be
1 31 cumulative for coverage of both mental health
1 32 conditions and other health or medical conditions
1 33 under the policy or contract.
1 34 b. Coverage required under this subsection shall
1 35 be as follows:
1 36 (1) For the treatment of mental illness, coverage
1 37 shall be for services provided by a licensed mental
1 38 health professional, or services provided in a
1 39 licensed hospital or health facility.
1 40 (2) For the treatment of alcohol or substance
1 41 abuse, coverage shall be for services provided by a
1 42 substance abuse counselor, as approved by the
1 43 department of human services, a licensed health
1 44 facility providing a program for the treatment of
1 45 alcohol or substance abuse approved by the department
1 46 of human services, or a substance abuse treatment and
1 47 rehabilitation facility, as licensed by the department
1 48 of public health pursuant to chapter 125.
1 49 3. This section applies to the following classes
1 50 of third-party payment provider contracts or policies
2 1 delivered, issued for delivery, continued, or renewed
2 2 in this state on or after January 1, 2005:
2 3 a. Individual or group accident and sickness
2 4 insurance providing coverage on an expense-incurred
2 5 basis.
2 6 b. An individual or group hospital or medical
2 7 service contract issued pursuant to chapter 509, 514,
2 8 or 514A.
2 9 c. A plan established pursuant to chapter 509A for
2 10 public employees.
2 11 d. An individual or group health maintenance
2 12 organization contract regulated under chapter 514B.
2 13 e. An individual or group Medicare supplemental
2 14 policy, unless coverage pursuant to such policy is
2 15 preempted by federal law.
2 16 f. Any other entity engaged in the business of
2 17 insurance, risk transfer, or risk retention, which is
2 18 subject to the jurisdiction of the commissioner.
2 19 g. An organized delivery system licensed by the
2 20 director of public health.
2 21 4. This section shall not apply to employers
2 22 actively engaged in business who, on at least fifty
2 23 percent of the employer's working days during the
2 24 preceding year, employed twenty-five or fewer full-
2 25 time eligible employees. In determining the number of
2 26 eligible employees, companies that are affiliated
2 27 companies or that are eligible to file a combined tax
2 28 return for purposes of state taxation are considered
2 29 one employer.
2 30 5. The commissioner shall adopt rules to
2 31 administer this section after consultation with the
2 32 mental health insurance advisory committee.
2 33 a. The commissioner shall appoint members to a
2 34 mental health insurance advisory committee. Members
2 35 shall include all sectors of society impacted by
2 36 issues associated with coverage of mental health
2 37 treatment by third-party payors including, but not
2 38 limited to, representatives of the insurance industry,
2 39 small and large employers, employee representatives
2 40 including labor, individual consumers, health care
2 41 providers, and other groups and individuals that may
2 42 be identified by the insurance division of the
2 43 department of commerce.
2 44 b. The committee shall meet upon the request of
2 45 the commissioner to review rules proposed under this
2 46 section by the commissioner, and to make suggestions
2 47 as appropriate."
2 48
2 49
2 50
3 1 MATT McCOY
3 2 SF 2298.206 80
3 3 av/sh
Text: S05201 Text: S05203 Text: S05200 - S05299 Text: S Index Bills and Amendments: General Index Bill History: General Index
© 2004 Cornell College and League of Women Voters of Iowa
Comments about this site or page?
webmaster@legis.iowa.gov.
Please remember that the person listed above does not vote on bills. Direct all comments concerning legislation to State Legislators.
Last update: Wed Mar 31 03:30:45 CST 2004
URL: /DOCS/GA/80GA/Legislation/S/05200/S05202/040330.html
jhf