Senate Study Bill 1045
SENATE FILE
BY (PROPOSED COMMITTEE ON
HUMAN RESOURCES BILL BY
CO=CHAIRPERSON RAGAN)
Passed Senate, Date Passed House, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act concerning third=party payment of health care coverage
2 costs for mental health conditions, and including substance
3 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.
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