Text: SF00231 Text: SF00233 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 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. 1 8 b. "Neurobiological disorder" means the following: 1 9 (1) Schizophrenia and other psychotic disorders. 1 10 (2) Affective disorders. 1 11 (3) Anxiety disorders. 1 12 (4) Pervasive developmental disorders. 1 13 (5) Attention deficit hyperactivity disorder and related 1 14 disorders. 1 15 (6) Disorders identified in childhood and adolescence. 1 16 The commissioner, by rule, shall identify the 1 17 neurobiological disorders covered by this definition, 1 18 consistent with the guidelines provided in the most recent 1 19 edition of the American psychiatric association's diagnostic 1 20 and statistical manual of mental disorders, as such 1 21 definitions may be amended from time to time. The 1 22 commissioner may adopt the definitions provided in the manual 1 23 by reference. 1 24 c. "Rates, terms, and conditions" means any lifetime or 1 25 annual payment limits, deductibles, copayments, coinsurance, 1 26 and any other cost-sharing requirements, out-of-pocket limits, 1 27 visit limitations, and any other financial component of 1 28 benefits coverage that affects the covered individual. 1 29 d. "Substance abuse" means a pattern of pathological use 1 30 of alcohol or a drug that causes impairment in social or 1 31 occupational functioning, or that produces physiological 1 32 dependency evidenced by physical tolerance or by physical 1 33 symptoms when the alcohol or drug is withdrawn. 1 34 2.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, 2 2 medical, and surgical expenses shall provide coverage benefits 2 3 for treatment for neurobiological disorders and underlying co- 2 4 morbidity based on rates, terms, and conditions that are no 2 5 more restrictive than the rates, terms, and conditions for 2 6 coverage benefits provided for other health or medical 2 7 conditions under 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 or 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 2 19 health, medical, or surgical coverage benefits. A policy, 2 20 contract, or plan subject to this section that imposes an 2 21 aggregate lifetime or annual limit on substantially all 2 22 health, medical, or surgical coverage benefits shall not 2 23 impose an aggregate lifetime or annual limit on treatment for 2 24 neurobiological disorders or underlying co-morbidity coverage 2 25 benefits that is less than the aggregate lifetime or annual 2 26 limit imposed on substantially all health or medical coverage 2 27 benefits. 2 28 c. Coverage required under this section shall be for the 2 29 treatment of neurobiological disorders and underlying co- 2 30 morbidity, for services provided by a health professional 2 31 licensed under chapter 147A, 148, 150A, 152, 154B, 154C, or 2 32 154D, for services provided in a hospital, clinic, office, 2 33 community mental health center, health care facility, 2 34 outpatient treatment facility, residential treatment facility, 2 35 halfway house, or similar facility for the provision of health 3 1 care services, and for services provided pursuant to the 3 2 comprehensive program for treatment for substance abuse 3 3 maintained by the department of public health pursuant to 3 4 section 125.12 in a hospital licensed under chapter 135B or a 3 5 facility licensed under chapter 125. 3 6 3. This section applies to the following classes of third- 3 7 party payment provider policies, contracts, or plans 3 8 delivered, issued for delivery, continued, or renewed in this 3 9 state on or after January 1, 2004: 3 10 a. Individual or group accident and sickness insurance 3 11 providing coverage on an expense-incurred basis. 3 12 b. An individual or group hospital or medical service 3 13 contract issued pursuant to chapter 509, 514, or 514A. 3 14 c. A plan established pursuant to chapter 509A for public 3 15 employees. 3 16 d. An individual or group health maintenance organization 3 17 contract regulated under chapter 514B. 3 18 e. An individual or group Medicare supplemental policy, 3 19 unless coverage pursuant to such policy is preempted by 3 20 federal law. 3 21 f. Any other entity engaged in the business of insurance, 3 22 risk transfer, or risk retention, which is subject to the 3 23 jurisdiction of the commissioner. 3 24 g. An organized delivery system licensed by the director 3 25 of public health. 3 26 4. The commissioner shall adopt rules pursuant to chapter 3 27 17A to administer this section. 3 28 Sec. 2. INSURANCE DIVISION STUDY IN CONJUNCTION WITH STATE 3 29 AUDITOR. 3 30 1. The insurance division of the department of commerce, 3 31 in conjunction with the auditor of state, shall conduct a 3 32 study of the cost of providing neurobiological disorder 3 33 coverage benefits in Iowa. 3 34 2. The study shall assess at least all of the following: 3 35 a. Identification of the costs attributed to treatment of 4 1 neurobiological disorders, and to underlying co-morbidity. 4 2 b. An estimate of the impact of mandated coverage on 4 3 health care coverage benefit costs and availability. 4 4 c. Actions taken by the division to ensure that third- 4 5 party payors subject to this Act are in compliance. 4 6 d. Identification of any segments of the population of 4 7 this state that may be excluded from or have limited access to 4 8 treatment, including the number of citizens that may be 4 9 excluded from or have limited access to treatment under third- 4 10 party payor policies or contracts provided by employers who 4 11 receive substantial revenue from public sources. 4 12 3. The insurance division shall submit a written report to 4 13 the general assembly on or before January 30, 2005. 4 14 Sec. 3. DEPARTMENT OF PUBLIC HEALTH STUDY. 4 15 1. The department of public health shall conduct a two- 4 16 year study of the mental health delivery system in Iowa, 4 17 beginning July 1, 2003. 4 18 2. The study shall include participation by at least all 4 19 of the following: 4 20 a. Representatives of professional health care groups 4 21 licensed under chapters 147A, 148, 150A, 152, 154B, 154C, and 4 22 154D. 4 23 b. Representatives of associations or other groups 4 24 representing hospitals, clinics, community mental health 4 25 centers, community corrections and prison corrections, health 4 26 care facilities, outpatient treatment facilities, and any 4 27 other facility offering mental health services. 4 28 c. County supervisors, representatives from the department 4 29 of human services, judges, mental health advocates, and other 4 30 state or county officials involved in the provision of mental 4 31 health services. 4 32 d. Consumers, family members, and patients. 4 33 3. The participants in the study shall assess the relevant 4 34 issues facing the mental health delivery system in Iowa, and 4 35 shall prepare a report with recommendations for presentation 5 1 to the general assembly no later than November 1, 2005. 5 2 EXPLANATION 5 3 This bill creates new Code section 514C.21 and provides 5 4 that coverage under a policy, contract, or plan for the 5 5 treatment of a neurobiological disorder and underlying co- 5 6 morbidity shall be based on rates, terms, and conditions that 5 7 are no less restrictive than for other health or medical 5 8 conditions under the policy, contract, or plan. 5 9 The bill defines "neurobiological disorder" as 5 10 schizophrenia and other psychotic disorders, affective 5 11 disorders, anxiety disorders, pervasive developmental 5 12 disorders, and attention deficit hyperactivity disorder and 5 13 related disorders, and disorders identified in childhood and 5 14 adolescence. The commissioner is directed to establish by 5 15 rule the definition of the neurobiological disorders 5 16 identified. The definitions established by the commissioner 5 17 are to be consistent with definitions provided in the most 5 18 recent edition of the American psychiatric association's 5 19 diagnostic and statistical manual of mental disorders, as such 5 20 definitions may be amended from time to time. The 5 21 commissioner may adopt the definitions provided in such manual 5 22 by reference. 5 23 "Co-morbidity" is defined as a coexisting condition or 5 24 disorder. "Substance abuse" is defined as a pattern of 5 25 pathological use of alcohol or a drug that causes impairment 5 26 in social or occupational functioning, or that produces 5 27 physiological dependency evidenced by physical tolerance or by 5 28 physical symptoms when the alcohol or drug is withdrawn. 5 29 The bill provides that the new Code section created applies 5 30 to third-party payment provider contracts or policies and 5 31 public employer plans delivered, issued for delivery, 5 32 continued, or renewed in this state on or after January 1, 5 33 2004. 5 34 The bill also provides that the insurance division of the 5 35 department of commerce, in conjunction with the state auditor, 6 1 is to conduct a study to determine the cost of providing 6 2 neurobiological disorder coverage benefits in Iowa. The 6 3 report is due to the general assembly on or before January 30, 6 4 2005. The division is directed to focus on certain specific 6 5 issues in analyzing the cost. 6 6 The department of public health shall also conduct a two- 6 7 year study of the mental health delivery system in Iowa. The 6 8 study begins July 1, 2003, and the report, with 6 9 recommendations, is due to the general assembly no later than 6 10 November 2005. Participation shall include specified 6 11 representatives from certain groups. 6 12 LSB 1243SS 80 6 13 jj/sh/8
Text: SF00231 Text: SF00233 Text: SF00200 - SF00299 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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