Text: SF00226 Text: SF00228 Text: SF00200 - SF00299 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 MENTAL HEALTH CONDITIONS. 1 3 1. For purposes of this section, unless the context 1 4 otherwise requires: 1 5 a. "Mental health condition" means a condition or disorder 1 6 involving mental illness or alcohol or substance abuse that 1 7 falls under any of the diagnostic categories listed in the 1 8 mental disorders section of the international classification 1 9 of disease, as periodically revised. 1 10 b. "Rates, terms, and conditions" means any lifetime 1 11 payment limits, deductibles, copayments, coinsurance, and any 1 12 other cost-sharing requirements, out-of-pocket limits, visit 1 13 limitations, and any other financial component of benefits 1 14 coverage that affects the covered individual. 1 15 2. a. Notwithstanding section 514C.6, a policy or 1 16 contract providing for third-party payment or prepayment of 1 17 health or medical expenses shall provide coverage benefits for 1 18 mental health conditions based on rates, terms, and conditions 1 19 which are no more restrictive than the rates, terms, and 1 20 conditions for coverage benefits provided for other health or 1 21 medical conditions under the policy or contract. 1 22 Additionally, any rates, terms, and conditions involving 1 23 deductibles, copayments, coinsurance, and any other cost- 1 24 sharing requirements shall be cumulative for coverage of both 1 25 mental health conditions and other health or medical 1 26 conditions under the policy or contract. 1 27 b. Coverage required under this subsection shall be as 1 28 follows: 1 29 (1) For the treatment of mental illness, coverage shall be 1 30 for services provided by a licensed mental health 1 31 professional, or services provided in a licensed hospital or 1 32 health facility. 1 33 (2) For the treatment of alcohol or substance abuse, 1 34 coverage shall be for services provided by a substance abuse 1 35 counselor, as approved by the department of human services, a 2 1 licensed health facility providing a program for the treatment 2 2 of alcohol or substance abuse approved by the department of 2 3 human services, or a substance abuse treatment and 2 4 rehabilitation facility, as licensed by the department of 2 5 public health pursuant to chapter 125. 2 6 3. This section applies to the following classes of third- 2 7 party payment provider contracts or policies delivered, issued 2 8 for delivery, continued, or renewed in this state on or after 2 9 January 1, 2004: 2 10 a. Individual or group accident and sickness insurance 2 11 providing coverage on an expense-incurred basis. 2 12 b. An individual or group hospital or medical service 2 13 contract issued pursuant to chapter 509, 514, or 514A. 2 14 c. A plan established pursuant to chapter 509A for public 2 15 employees. 2 16 d. An individual or group health maintenance organization 2 17 contract regulated under chapter 514B. 2 18 e. An individual or group Medicare supplemental policy, 2 19 unless coverage pursuant to such policy is preempted by 2 20 federal law. 2 21 f. Any other entity engaged in the business of insurance, 2 22 risk transfer, or risk retention, which is subject to the 2 23 jurisdiction of the commissioner. 2 24 g. An organized delivery system licensed by the director 2 25 of public health. 2 26 4. This section shall not apply to employers actively 2 27 engaged in business who, on at least fifty percent of the 2 28 employer's working days during the preceding year, employed 2 29 twenty-five or fewer full-time eligible employees. In 2 30 determining the number of eligible employees, companies that 2 31 are affiliated companies or that are eligible to file a 2 32 combined tax return for purposes of state taxation are 2 33 considered one employer. 2 34 5. The commissioner shall adopt rules to administer this 2 35 section after consultation with the mental health insurance 3 1 advisory committee. 3 2 a. The commissioner shall appoint members to a mental 3 3 health insurance advisory committee. Members shall include 3 4 all sectors of society impacted by issues associated with 3 5 coverage of mental health treatment by third-party payors 3 6 including, but not limited to, representatives of the 3 7 insurance industry, small and large employers, employee 3 8 representatives including labor, individual consumers, health 3 9 care providers, and other groups and individuals that may be 3 10 identified by the insurance division of the department of 3 11 commerce. 3 12 b. The committee shall meet upon the request of the 3 13 commissioner to review rules proposed under this section by 3 14 the commissioner, and to make suggestions as appropriate. 3 15 EXPLANATION 3 16 This bill creates new Code section 514C.21 and provides 3 17 that a policy or contract providing for third-party payment or 3 18 prepayment of health or medical expenses must provide coverage 3 19 benefits for mental health conditions based on rates, terms, 3 20 and conditions which are no more restrictive than the rates, 3 21 terms, and conditions associated with coverage benefits 3 22 provided for other conditions under the policy or contract. 3 23 Mental health conditions are defined to mean a condition or 3 24 disorder involving mental illness or alcohol or substance 3 25 abuse that falls under any of the diagnostic categories listed 3 26 in the mental disorders section of the international 3 27 classification of disease, as periodically updated. 3 28 Employers with 25 or fewer employees are expressly exempted 3 29 from the requirements of the bill. 3 30 The bill also requires the insurance commissioner to adopt 3 31 rules to administer this section, after consultation with the 3 32 new mental health insurance advisory committee, whose members 3 33 are appointed by the commissioner from business, consumer, and 3 34 health groups. 3 35 LSB 2033XS 80 4 1 jj/cl/14
Text: SF00226 Text: SF00228 Text: SF00200 - SF00299 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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