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1 33 symptoms when the alcohol or drug is withdrawn.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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