Text: SF02055 Text: SF02057 Text: SF02000 - SF02099 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, 2005:
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, delivered,
3 19 continued, or renewed in this state on or after January 1,
3 20 2005, must provide coverage benefits for mental health
3 21 conditions based on rates, terms, and conditions which are no
3 22 more restrictive than the rates, terms, and conditions
3 23 associated with coverage benefits provided for other
3 24 conditions under the policy or contract. Mental health
3 25 conditions are defined to mean a condition or disorder
3 26 involving mental illness or alcohol or substance abuse that
3 27 falls under any of the diagnostic categories listed in the
3 28 mental disorders section of the international classification
3 29 of disease, as periodically updated.
3 30 Employers with 25 or fewer employees are expressly exempted
3 31 from the requirements of the bill.
3 32 The bill also requires the insurance commissioner to adopt
3 33 rules to administer this section, after consultation with the
3 34 new mental health insurance advisory committee, whose members
3 35 are appointed by the commissioner from business, consumer, and
4 1 health groups.
4 2 LSB 5893XS 80
4 3 av/gg/14
Text: SF02055 Text: SF02057 Text: SF02000 - SF02099 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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