House File 96HOUSE FILE BY JOCHUM and SMITH Passed House, Date Passed Senate, 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, including alcohol or 3 substance abuse treatment services. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 1682HH 82 6 av/es/88 PAG LIN 1 1 Section 1. NEW SECTION. 514C.23 MANDATED COVERAGE FOR 1 2 MENTAL HEALTH CONDITIONS == MENTAL HEALTH INSURANCE ADVISORY 1 3 COMMITTEE. 1 4 1. For purposes of this section, unless the context 1 5 otherwise requires: 1 6 a. "Mental health condition" means a condition or disorder 1 7 involving mental illness or alcohol or substance abuse that 1 8 falls under any of the diagnostic categories listed in the 1 9 mental disorders section of the international classification 1 10 of disease, as periodically revised. 1 11 b. "Rates, terms, and conditions" means any lifetime 1 12 payment limits, deductibles, copayments, coinsurance, and any 1 13 other cost=sharing requirements, out=of=pocket limits, visit 1 14 limitations, and any other financial component of benefits 1 15 coverage that affects the covered individual. 1 16 2. a. Notwithstanding section 514C.6, a policy or 1 17 contract providing for third=party payment or prepayment of 1 18 health or medical expenses shall provide coverage benefits for 1 19 mental health conditions based on rates, terms, and conditions 1 20 which are no more restrictive than the rates, terms, and 1 21 conditions for coverage benefits provided for other health or 1 22 medical conditions under the policy or contract. 1 23 Additionally, any rates, terms, and conditions involving 1 24 deductibles, copayments, coinsurance, and any other cost= 1 25 sharing requirements shall be cumulative for coverage of both 1 26 mental health conditions and other health or medical 1 27 conditions under the policy or contract. 1 28 b. Coverage required under this subsection shall be as 1 29 follows: 1 30 (1) For the treatment of mental illness, coverage shall be 1 31 for services provided by a licensed mental health professional 1 32 or services provided in a licensed hospital or health 1 33 facility. 1 34 (2) For the treatment of alcohol or substance abuse, 1 35 coverage shall be for services provided by a substance abuse 2 1 counselor, as approved by the department of human services; a 2 2 licensed health facility providing a program for the treatment 2 3 of alcohol or substance abuse approved by the department of 2 4 human services; or a substance abuse treatment and 2 5 rehabilitation facility, as licensed by the department of 2 6 public health pursuant to chapter 125. 2 7 3. This section applies to the following classes of third= 2 8 party payment provider contracts or policies delivered, issued 2 9 for delivery, continued, or renewed in this state on or after 2 10 January 1, 2008: 2 11 a. Individual or group accident and sickness insurance 2 12 providing coverage on an expense=incurred basis. 2 13 b. An individual or group hospital or medical service 2 14 contract issued pursuant to chapter 509, 514, or 514A. 2 15 c. A plan established pursuant to chapter 509A for public 2 16 employees. 2 17 d. An individual or group health maintenance organization 2 18 contract regulated under chapter 514B. 2 19 e. An individual or group Medicare supplemental policy, 2 20 unless coverage pursuant to such policy is preempted by 2 21 federal law. 2 22 f. Any other entity engaged in the business of insurance, 2 23 risk transfer, or risk retention, which is subject to the 2 24 jurisdiction of the commissioner. 2 25 g. An organized delivery system licensed by the director 2 26 of public health. 2 27 4. The commissioner shall adopt rules to administer this 2 28 section after consultation with the mental health insurance 2 29 advisory committee. 2 30 a. The commissioner shall appoint members to a mental 2 31 health insurance advisory committee. Members shall include 2 32 all sectors of society impacted by issues associated with 2 33 coverage of mental health treatment by third=party payors 2 34 including but not limited to representatives of the insurance 2 35 industry, small and large employers, employee representatives 3 1 including labor, individual consumers, health care providers, 3 2 and other groups and individuals that may be identified by the 3 3 insurance division of the department of commerce. 3 4 b. The committee shall meet upon the request of the 3 5 commissioner to review rules proposed under this section by 3 6 the commissioner, and to make suggestions as appropriate. 3 7 Sec. 2. Section 514C.22, Code 2007, is repealed effective 3 8 January 1, 2008. 3 9 EXPLANATION 3 10 This bill creates new Code section 514C.23 and provides 3 11 that a policy or contract providing for third=party payment or 3 12 prepayment of health or medical expenses must provide coverage 3 13 benefits for mental health conditions based on rates, terms, 3 14 and conditions which are no more restrictive than the rates, 3 15 terms, and conditions associated with coverage benefits 3 16 provided for other conditions under the policy or contract. 3 17 Mental health conditions are defined to mean a condition or 3 18 disorder involving mental illness or alcohol or substance 3 19 abuse that falls under any of the diagnostic categories listed 3 20 in the mental disorders section of the international 3 21 classification of disease, as periodically updated. 3 22 The bill also requires the insurance commissioner to adopt 3 23 rules to administer the new Code section, after consultation 3 24 with the new mental health insurance advisory committee, whose 3 25 members are appointed by the commissioner from business, 3 26 consumer, and health groups. 3 27 Code section 514C.22, which currently mandates coverage for 3 28 certain biologically based mental illnesses is repealed 3 29 effective January 1, 2008. 3 30 LSB 1682HH 82 3 31 av:nh/es/88