Text: SF02057 Text: SF02059 Text: SF02000 - SF02099 Text: SF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 509A.6A BIOLOGICALLY BASED
1 2 MENTAL ILLNESS COVERAGE FOR STATE EMPLOYEES.
1 3 1. For purposes of this section:
1 4 a. "Biologically based disease" means any of the
1 5 following:
1 6 (1) Schizophrenia.
1 7 (2) Bipolar disorders.
1 8 (3) Major depressive disorders.
1 9 (4) Schizo-affective disorders.
1 10 (5) Obsessive-compulsive disorders.
1 11 (6) Pervasive developmental disorders.
1 12 (7) Autistic disorders.
1 13 b. "State employee" means a person who is a paid employee
1 14 of the state of Iowa, including a paid employee of the state
1 15 board of regents.
1 16 c. "State health or medical group insurance plan" means a
1 17 plan as defined in section 509A.13A.
1 18 2. Notwithstanding the uniformity of treatment
1 19 requirements of section 514C.6, a state health or medical
1 20 group insurance plan for state employees shall provide
1 21 coverage benefits for treatment services for biologically
1 22 based mental illness that shall be provided on terms and
1 23 conditions that are no more restrictive than the terms and
1 24 conditions for other medical conditions under such plan.
1 25 3. The commissioner, by rule, shall define the
1 26 biologically based mental illnesses identified in subsection
1 27 1. Definitions established by the commissioner shall be
1 28 consistent with definitions provided in the most recent
1 29 edition of the American psychiatric association's diagnostic
1 30 and statistical manual of mental disorders, as such
1 31 definitions may be amended from time to time. The
1 32 commissioner may adopt the definitions provided in such manual
1 33 by reference.
1 34 4. a. This section does not apply to coverage benefits
1 35 for treatment services for alcohol or drug addiction.
2 1 b. This section does not apply to accident only, specified
2 2 disease, short-term hospital or medical, hospital confinement
2 3 indemnity, credit, dental, vision, Medicare supplement, long-
2 4 term care, basic hospital and medical-surgical expense
2 5 coverage as defined by the commissioner, disability income
2 6 insurance coverage, coverage issued as a supplement to
2 7 liability insurance, workers' compensation or similar
2 8 insurance, or automobile medical payment insurance, or
2 9 individual accident and sickness policies issued to
2 10 individuals or to individual members of a member association.
2 11 5. A plan covered under this section may manage the
2 12 benefits provided under this section provided through common
2 13 methods including, but not limited to, providing payment of
2 14 benefits or providing care and treatment under a capitated
2 15 payment system, prospective reimbursement rate system,
2 16 utilization control system, incentive system for the use of
2 17 least restrictive and least costly levels of care, a preferred
2 18 provider contract limiting choice of specific providers, or
2 19 any other system, method, or organization designed to ensure
2 20 that services are medically necessary and clinically
2 21 appropriate.
2 22 6. a. A plan covered under this section shall not impose
2 23 an aggregate annual or lifetime limit on biologically based
2 24 mental illness coverage benefits unless the plan imposes an
2 25 aggregate annual or lifetime limit on substantially all
2 26 medical and surgical coverage benefits.
2 27 b. A plan covered under this section that imposes an
2 28 aggregate annual or lifetime limit on substantially all
2 29 medical and surgical coverage benefits shall not impose an
2 30 aggregate annual or lifetime limit on biologically based
2 31 mental illness coverage benefits which is less than the
2 32 aggregate annual or lifetime limit imposed on substantially
2 33 all medical and surgical coverage benefits.
2 34 7. A plan covered under this section shall at a minimum
2 35 allow each covered individual thirty inpatient days and fifty-
3 1 two outpatient visits annually. The plan may also include
3 2 deductibles, coinsurance, or copayments, provided the amounts
3 3 and extents of such deductibles, coinsurance, or copayments
3 4 applicable to other medical or surgical services coverage
3 5 under the plan are the same. It is not a violation of this
3 6 section if the plan excludes entirely from coverage, benefits
3 7 for the cost of providing the following:
3 8 a. Marital, family, educational, developmental, or
3 9 training services.
3 10 b. Care that is substantially custodial in nature.
3 11 c. Services and supplies that are not medically necessary
3 12 and clinically appropriate.
3 13 d. Experimental treatments.
3 14 8. This section applies to plans established pursuant to
3 15 this chapter that are delivered, issued for delivery,
3 16 continued, or renewed in this state on or after January 1,
3 17 2005.
3 18 EXPLANATION
3 19 This bill creates a new Code section 509A.6A, providing
3 20 that a state health or medical group insurance plan for state
3 21 employees shall provide coverage benefits for treatment
3 22 services for biologically based mental illness on terms and
3 23 conditions that are no more restrictive than the terms and
3 24 conditions for other medical conditions under the plan.
3 25 The bill provides that the mandated coverage does not apply
3 26 to coverage benefits for treatment services for alcohol or
3 27 drug addiction.
3 28 The bill defines "biologically based mental illness" as
3 29 psychiatric illnesses including schizophrenia, bipolar
3 30 disorders, major depressive disorders, schizo-affective
3 31 disorders, obsessive-compulsive disorders, pervasive
3 32 developmental disorders, and autistic disorders. The
3 33 commissioner is directed to establish by rule the definitions
3 34 of the biologically based mental illnesses identified. The
3 35 definitions established by the commissioner are to be
4 1 consistent with definitions provided in the most recent
4 2 edition of the American psychiatric association's diagnostic
4 3 and statistical manual of mental disorders, as such
4 4 definitions may be amended from time to time. The
4 5 commissioner may adopt the definitions provided in such manual
4 6 by reference.
4 7 The bill defines a "state employee" as a person who is a
4 8 paid employee of the state of Iowa, including a paid employee
4 9 of the state board of regents. The bill also defines "state
4 10 health or medical group insurance plan" to mean a plan as
4 11 defined in Code section 509A.13A.
4 12 The bill does not apply to accident only, specified
4 13 disease, short-term hospital or medical, hospital confinement
4 14 indemnity, credit, dental, vision, Medicare supplement, long-
4 15 term care, basic hospital and medical-surgical expense
4 16 coverage as defined by the commissioner, disability income
4 17 insurance coverage, coverage issued as a supplement to
4 18 liability insurance, workers' compensation or similar
4 19 insurance, or automobile medical payment insurance, or
4 20 individual accident and sickness policies issued to
4 21 individuals or to individual members of a member association.
4 22 The bill provides that a plan covered under this Code
4 23 section may manage the benefits provided through common
4 24 methods including, but not limited to, providing payment of
4 25 benefits or providing care and treatment under a capitated
4 26 payment system, prospective reimbursement rate system,
4 27 utilization control system, incentive system for the use of
4 28 least restrictive and least costly levels of care, a preferred
4 29 provider contract limiting choice of specific providers, or
4 30 any other system, method, or organization designed to ensure
4 31 that services are medically necessary and clinically
4 32 appropriate.
4 33 The bill provides that a plan covered under this Code
4 34 section shall not impose an aggregate annual or lifetime limit
4 35 on biologically based mental illness coverage benefits unless
5 1 the plan imposes an aggregate annual or lifetime limit on
5 2 substantially all medical and surgical coverage benefits, and
5 3 a plan that imposes an aggregate annual or lifetime limit on
5 4 substantially all medical and surgical coverage benefits shall
5 5 not impose an aggregate annual or lifetime limit on
5 6 biologically based mental illness coverage benefits that is
5 7 less than that imposed on substantially all medical and
5 8 surgical coverage benefits.
5 9 The bill requires a plan covered under this Code section to
5 10 allow for a minimum of 30 inpatient and 52 outpatient visits
5 11 annually for each person covered under the plan. Any
5 12 deductibles, coinsurance, or copayments under the plan must be
5 13 the same as the deductibles, coinsurance, or copayments
5 14 applicable to other medical or surgical services covered under
5 15 the plan. The plan may exclude all of the following: (1)
5 16 marital, family, educational, developmental, or training
5 17 services; (2) care that is substantially custodial in nature;
5 18 (3) services and supplies that are not medically necessary and
5 19 clinically appropriate; and (4) experimental treatments.
5 20 The bill provides that the new Code section created applies
5 21 to plans established pursuant to Code chapter 509A that are
5 22 delivered, issued for delivery, continued, or renewed in this
5 23 state on or after January 1, 2005.
5 24 LSB 5546SS 80
5 25 av/gg/14
Text: SF02057 Text: SF02059 Text: SF02000 - SF02099 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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