Senate File 48 - Introduced
SENATE FILE
BY RAGAN, DOTZLER, DANIELSON, DVORSKY,
HATCH, SENG, DEARDEN, RIELLY,
HANCOCK, WOOD, BOLKCOM, QUIRMBACH,
McCOY, WARNSTADT, COURTNEY,
SCHOENJAHN, GRONSTAL, KIBBIE,
BLACK, STEWART, CONNOLLY, FRAISE,
BEALL, KREIMAN, and HORN
Passed Senate, Date Passed House, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to third=party payment of health care coverage
2 costs for mental health conditions, and including substance
3 and alcohol abuse treatment services.
4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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PAG LIN
1 1 Section 1. NEW SECTION. 514C.22 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 any of the following:
1 6 (1) Schizophrenia and other psychotic disorders.
1 7 (2) Bipolar disorders.
1 8 (3) Major depressive disorders.
1 9 (4) Schizo=affective disorders.
1 10 (5) Anxiety disorders, including post=traumatic stress
1 11 disorders and obsessive=compulsive disorders.
1 12 (6) Pervasive developmental disorders, including autistic
1 13 disorders.
1 14 (7) Alcohol or substance abuse.
1 15 (8) Eating disorders, including but not limited to bulimia
1 16 nervosa and anorexia nervosa.
1 17 b. "Rates, terms, and conditions" means any lifetime
1 18 payment limits, deductibles, copayments, coinsurance, and any
1 19 other cost=sharing requirements, out=of=pocket limits, visit
1 20 limitations, and any other financial component of benefits
1 21 coverage that affects the covered individual.
1 22 2. a. Notwithstanding section 514C.6, a policy or
1 23 contract providing for third=party payment or prepayment of
1 24 health or medical expenses shall provide coverage benefits for
1 25 mental health conditions based on rates, terms, and conditions
1 26 that are no more restrictive than the rates, terms, and
1 27 conditions for coverage benefits provided for other health or
1 28 medical conditions under the policy or contract.
1 29 Additionally, any rates, terms, and conditions involving
1 30 deductibles, copayments, coinsurance, and any other cost=
1 31 sharing requirements shall be cumulative for coverage of both
1 32 mental health conditions and other health or medical
1 33 conditions under the policy or contract.
1 34 b. Coverage required under this subsection shall be as
1 35 follows:
2 1 (1) For the treatment of mental illness, coverage shall be
2 2 for services provided by a licensed mental health
2 3 professional, or services provided in a licensed hospital or
2 4 health facility.
2 5 (2) For the treatment of alcohol or substance abuse,
2 6 coverage shall be for services provided by a substance abuse
2 7 counselor, as approved by the department of human services, a
2 8 licensed health facility providing a program for the treatment
2 9 of alcohol or substance abuse approved by the department of
2 10 human services, or a substance abuse treatment and
2 11 rehabilitation facility, as licensed by the department of
2 12 public health pursuant to chapter 125.
2 13 3. This section applies to the following classes of third=
2 14 party payment provider contracts or policies delivered, issued
2 15 for delivery, continued, or renewed in this state on or after
2 16 January 1, 2006:
2 17 a. Individual or group accident and sickness insurance
2 18 providing coverage on an expense=incurred basis.
2 19 b. An individual or group hospital or medical service
2 20 contract issued pursuant to chapter 509, 514, or 514A.
2 21 c. A plan established pursuant to chapter 509A for public
2 22 employees.
2 23 d. An individual or group health maintenance organization
2 24 contract regulated under chapter 514B.
2 25 e. An individual or group Medicare supplemental policy,
2 26 unless coverage pursuant to such policy is preempted by
2 27 federal law.
2 28 f. Any other entity engaged in the business of insurance,
2 29 risk transfer, or risk retention, which is subject to the
2 30 jurisdiction of the commissioner.
2 31 g. An organized delivery system licensed by the director
2 32 of public health.
2 33 4. This section shall not apply to employers actively
2 34 engaged in business who, on at least fifty percent of the
2 35 employer's working days during the preceding calendar year,
3 1 employed twenty=five or fewer full=time eligible employees.
3 2 In determining the number of eligible employees, companies
3 3 that are affiliated companies or that are eligible to file a
3 4 combined tax return for purposes of state taxation are
3 5 considered one employer.
3 6 5. The commissioner, by rule, shall define the mental
3 7 health conditions identified in subsection 1. Definitions
3 8 established by the commissioner shall be consistent with
3 9 definitions provided in the most recent edition of the
3 10 American psychiatric association's diagnostic and statistical
3 11 manual of mental disorders, as such definitions may be amended
3 12 from time to time. The commissioner may adopt the definitions
3 13 provided in such manual by reference.
3 14 6. The commissioner shall adopt rules to administer this
3 15 section after consultation with the mental health insurance
3 16 advisory committee.
3 17 a. The commissioner shall appoint members to a mental
3 18 health insurance advisory committee. Members shall include
3 19 representatives of all sectors of society impacted by issues
3 20 associated with coverage of mental health treatment by third=
3 21 party payors including, but not limited to, representatives of
3 22 the insurance industry, small and large employers, employee
3 23 representatives including labor, individual consumers, health
3 24 care providers, and other groups and individuals that may be
3 25 identified by the insurance division of the department of
3 26 commerce.
3 27 b. The committee shall meet upon the request of the
3 28 commissioner to review rules proposed under this section by
3 29 the commissioner, and to make suggestions as appropriate.
3 30 EXPLANATION
3 31 This bill creates new Code section 514C.22 and provides
3 32 that a policy or contract providing for third=party payment or
3 33 prepayment of health or medical expenses, delivered,
3 34 continued, or renewed in this state on or after January 1,
3 35 2006, must provide coverage benefits for mental health
4 1 conditions based on rates, terms, and conditions which are no
4 2 more restrictive than the rates, terms, and conditions
4 3 associated with coverage benefits provided for other
4 4 conditions under the policy or contract. Mental health
4 5 conditions are defined to mean any of the following:
4 6 schizophrenia and other psychotic disorders; bipolar
4 7 disorders; major depressive disorders; schizo=affective
4 8 disorders; anxiety disorders, including post=traumatic stress
4 9 disorders and obsessive=compulsive disorders; pervasive
4 10 developmental disorders, including autistic disorders; and
4 11 alcohol or substance abuse; or eating disorders, including but
4 12 not limited to bulimia nervosa and anorexia nervosa.
4 13 Employers with 25 or fewer employees are expressly exempted
4 14 from the requirements of the bill.
4 15 The bill directs the insurance commissioner to establish by
4 16 rule the definitions of the mental health conditions
4 17 identified. The definitions established by the commissioner
4 18 are to be consistent with definitions provided in the most
4 19 recent edition of the American psychiatric association's
4 20 diagnostic and statistical manual of mental disorders, as such
4 21 definitions may be amended from time to time. The
4 22 commissioner may adopt the definitions provided in such manual
4 23 by reference.
4 24 The bill also requires the insurance commissioner to adopt
4 25 rules to administer this section, after consultation with the
4 26 new mental health insurance advisory committee, whose members
4 27 are appointed by the commissioner from business, consumer, and
4 28 health groups.
4 29 LSB 1193XS 81
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