Text: SF00242 Text: SF00244 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. a. Notwithstanding section 514C.6, a policy or
1 4 contract providing for third-party payment or prepayment of
1 5 health or medical expenses shall provide coverage benefits for
1 6 mental health conditions based on rates, terms, and conditions
1 7 that are no more restrictive than the rates, terms, and
1 8 conditions for coverage benefits provided for other health or
1 9 medical conditions under the policy or contract.
1 10 Additionally, any rates, terms, and conditions involving
1 11 deductibles, copayments, coinsurance, and any other cost-
1 12 sharing requirements shall be cumulative for coverage of both
1 13 mental health conditions and other health or medical
1 14 conditions under the policy or contract.
1 15 b. Coverage required under this subsection shall be as
1 16 follows:
1 17 (1) For the treatment of mental illness, coverage shall be
1 18 for services provided by a licensed mental health
1 19 professional, or services provided in a licensed hospital or
1 20 health facility.
1 21 (2) For the treatment of alcohol or substance abuse,
1 22 coverage shall be for services provided by a substance abuse
1 23 counselor, as approved by the department of human services, a
1 24 licensed health facility providing a program for the treatment
1 25 of alcohol or substance abuse approved by the department of
1 26 human services, or a licensed substance abuse treatment and
1 27 rehabilitation facility.
1 28 2. This section applies to the following classes of third-
1 29 party payment provider contracts or policies delivered, issued
1 30 for delivery, continued, or renewed in this state on or after
1 31 January 1, 2004:
1 32 a. Individual or group accident and sickness insurance
1 33 providing coverage on an expense-incurred basis.
1 34 b. An individual or group hospital or medical service
1 35 contract issued pursuant to chapter 509, 514, or 514A.
2 1 c. An individual or group health maintenance organization
2 2 contract regulated under chapter 514B.
2 3 d. An individual or group Medicare supplemental policy,
2 4 unless coverage pursuant to such policy is preempted by
2 5 federal law.
2 6 e. Any other entity engaged in the business of insurance,
2 7 risk transfer, or risk retention, which is subject to the
2 8 jurisdiction of the commissioner.
2 9 f. An organized delivery system licensed by the director
2 10 of public health.
2 11 3. For purposes of this section, unless the context
2 12 otherwise requires:
2 13 a. "Mental health condition" means a condition or disorder
2 14 involving mental illness or alcohol or substance abuse that
2 15 falls under any of the diagnostic categories listed in the
2 16 mental disorders section of the international classification
2 17 of disease, as periodically revised.
2 18 b. "Rates, terms, and conditions" means any lifetime
2 19 payment limits, deductibles, copayments, coinsurance, and any
2 20 other cost-sharing requirements, out-of-pocket limits, visit
2 21 limitations, and any other financial component of benefits
2 22 coverage that affects the covered individual.
2 23 EXPLANATION
2 24 This bill creates new Code section 514C.21 and provides
2 25 that a policy or contract providing for third-party payment or
2 26 prepayment of health or medical expenses must provide coverage
2 27 benefits for mental health conditions based on rates, terms,
2 28 and conditions that are no more restrictive than the rates,
2 29 terms, and conditions associated with coverage benefits
2 30 provided for other conditions under the policy or contract.
2 31 Mental health conditions are defined to mean a condition or
2 32 disorder involving mental illness or alcohol or substance
2 33 abuse that falls under any of the diagnostic categories listed
2 34 in the mental disorders section of the international
2 35 classification of disease, as periodically updated.
3 1 LSB 2172SS 80
3 2 jj/cl/14
Text: SF00242 Text: SF00244 Text: SF00200 - SF00299 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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