House File 234 - Introduced HOUSE FILE BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO HF 139) (SUCCESSOR TO HSB 6) Passed House, Date Passed Senate, Date Vote: Ayes Nays Vote: Ayes Nays Approved A BILL FOR 1 An Act requiring health insurance coverage for costs relating to 2 mental health conditions, including alcohol or substance abuse 3 treatment services. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 1524HZ 83 6 av/nh/8 PAG LIN 1 1 Section 1. NEW SECTION. 514C.24 EQUALITY IN HEALTH CARE 1 2 COVERAGE AND VETERANS WELLNESS ACT. 1 3 1. This section shall be known and may be cited as the 1 4 "Equality in Health Care Coverage and Veterans Wellness Act". 1 5 2. For purposes of this section, unless the context 1 6 otherwise requires: 1 7 a. "Mental health condition" means a condition or disorder 1 8 involving mental illness or alcohol or substance abuse as 1 9 defined by the commissioner of insurance by rule, consistent 1 10 with the diagnostic categories listed in the mental disorders 1 11 section of the most recent version of the diagnostic and 1 12 statistical manual of mental disorders. 1 13 b. "Rates, terms, and conditions" means any lifetime 1 14 payment limits, deductibles, copayments, coinsurance, and any 1 15 other cost=sharing requirements, out=of=pocket limits, visit 1 16 limitations, and any other financial component of benefits 1 17 coverage that affects the covered individual. 1 18 3. a. Notwithstanding section 514C.6, a policy, contract, 1 19 or plan providing for third=party payment or prepayment of 1 20 health or medical expenses shall provide coverage benefits for 1 21 mental health conditions based on rates, terms, and conditions 1 22 which are no more restrictive than the rates, terms, and 1 23 conditions for coverage benefits provided for other health or 1 24 medical conditions under the policy, contract, or plan. 1 25 Additionally, any rates, terms, and conditions involving 1 26 deductibles, copayments, coinsurance, and any other 1 27 cost=sharing requirements shall be cumulative for coverage of 1 28 both mental health conditions and other health or medical 1 29 conditions under the policy, contract, or plan. 1 30 b. Coverage required under this subsection shall be as 1 31 follows: 1 32 (1) For the treatment of mental illness, coverage shall be 1 33 for services provided by a licensed mental health 1 34 professional, as defined in section 228.1, subsection 6, or 1 35 services provided in a licensed hospital or health facility. 2 1 (2) For the treatment of alcohol or substance abuse, 2 2 coverage shall be for services provided by a substance abuse 2 3 treatment and rehabilitation facility, as licensed by the 2 4 department of public health pursuant to chapter 125. 2 5 4. This section applies to the following classes of 2 6 third=party payment provider policies, contracts, or plans 2 7 delivered, issued for delivery, continued, or renewed in this 2 8 state on or after January 1, 2010: 2 9 a. Individual or group accident and sickness insurance 2 10 providing coverage on an expense=incurred basis. 2 11 b. An individual or group hospital or medical service 2 12 contract issued pursuant to chapter 509, 514, or 514A. 2 13 c. A plan established pursuant to chapter 509A for public 2 14 employees. 2 15 d. An individual or group health maintenance organization 2 16 contract regulated under chapter 514B. 2 17 e. Any other entity engaged in the business of insurance, 2 18 risk transfer, or risk retention, which is subject to the 2 19 jurisdiction of the commissioner. 2 20 f. An organized delivery system licensed by the director 2 21 of public health. 2 22 5. The division of mental health and disability services 2 23 of the department of human services and the division of 2 24 behavioral health of the department of public health shall 2 25 coordinate with the Iowa department of veterans affairs to 2 26 maximize access to mental health and substance abuse treatment 2 27 for veterans. 2 28 6. This section shall not apply to accident=only, 2 29 specified disease, short=term hospital or medical, hospital 2 30 confinement indemnity, credit, dental, vision, Medicare 2 31 supplement, long=term care, basic hospital and 2 32 medical=surgical expense coverage as defined by the 2 33 commissioner, disability income insurance coverage, coverage 2 34 issued as a supplement to liability insurance, workers' 2 35 compensation or similar insurance, or automobile medical 3 1 payment insurance. 3 2 Sec. 2. Section 514C.22, Code 2009, is repealed effective 3 3 January 1, 2010. 3 4 EXPLANATION 3 5 This bill creates new Code section 514C.24 entitled the 3 6 "Equality in Heath Care Coverage and Veterans Wellness Act" 3 7 and provides that, effective January 1, 2010, a policy, 3 8 contract, or plan providing for third=party payment or 3 9 prepayment of health or medical expenses must provide coverage 3 10 benefits for mental health conditions based on rates, terms, 3 11 and conditions which are no more restrictive than the rates, 3 12 terms, and conditions associated with coverage benefits 3 13 provided for other conditions under the policy, contract, or 3 14 plan. "Mental health condition" means a condition or disorder 3 15 involving mental illness or alcohol or substance abuse as 3 16 defined by the commissioner of insurance, by rule, consistent 3 17 with the diagnostic categories listed in the mental disorders 3 18 section of the most recent version of the diagnostic and 3 19 statistical manual of mental disorders. 3 20 The bill also requires the division of mental health and 3 21 disability services of the department of human services and 3 22 the division of behavioral health of the department of public 3 23 health to coordinate with the Iowa department of veterans 3 24 affairs to maximize access to mental health and substance 3 25 abuse treatment for veterans. 3 26 Code section 514C.22, which currently mandates coverage for 3 27 certain biologically based mental illnesses, is repealed 3 28 effective January 1, 2010. 3 29 LSB 1524HZ 83 3 30 av/nh/8