House Study Bill 590 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON COMMERCE BILL BY CHAIRPERSON PETERSEN) A BILL FOR An Act requiring health insurance coverage for costs relating 1 to mental health conditions, including alcohol or substance 2 abuse treatment services costs, and requiring coordination 3 of services to maximize access to mental health and 4 substance abuse treatment for veterans, and including 5 effective date provisions. 6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 7 TLSB 5514HC (7) 83 av/rj

H.F. _____ Section 1. Section 135H.3, subsection 2, Code Supplement 1 2009, is amended to read as follows: 2 2. If a child is diagnosed with a biologically based 3 mental illness mental health condition as defined in section 4 514C.22 514C.26 and meets the medical assistance program 5 criteria for admission to a psychiatric medical institution for 6 children, the child shall be deemed to meet the acuity criteria 7 for medically necessary inpatient benefits under a group 8 policy, contract, or plan providing for third-party payment or 9 prepayment of health, medical, and surgical coverage benefits 10 issued by a carrier, as defined in section 513B.2, or by an 11 organized delivery system authorized under 1993 Iowa Acts, 12 ch. 158, that is subject to section 514C.22 514C.26 . Such 13 medically necessary benefits shall not be excluded or denied as 14 care that is substantially custodial in nature under section 15 514C.22, subsection 8 , paragraph “b” . 16 Sec. 2. NEW SECTION . 514C.26 Equality in health care 17 coverage and veterans wellness Act. 18 1. This section shall be known and may be cited as the 19 “Equality in Health Care Coverage and Veterans Wellness Act” . 20 2. For purposes of this section, unless the context 21 otherwise requires: 22 a. “Mental health condition” means a condition or disorder 23 involving mental illness or alcohol or substance abuse as 24 defined by the commissioner of insurance by rule, consistent 25 with the diagnostic categories listed in the mental disorders 26 section of the most recent version of the diagnostic and 27 statistical manual of mental disorders of the American 28 psychiatric association. 29 b. “Rates, terms, and conditions” means any lifetime 30 payment limits, deductibles, copayments, coinsurance, and any 31 other cost-sharing requirements, out-of-pocket limits, visit 32 limitations, and any other financial component of benefits 33 coverage that affects the covered individual. 34 3. a. Notwithstanding the uniformity of treatment 35 -1- LSB 5514HC (7) 83 av/rj 1/ 4

H.F. _____ requirements of section 514C.6, a policy, contract, or plan 1 providing for third-party payment or prepayment of health or 2 medical expenses shall provide coverage benefits for mental 3 health conditions based on rates, terms, and conditions which 4 are no more restrictive than the rates, terms, and conditions 5 for coverage benefits provided for other health or medical 6 conditions under the policy, contract, or plan. Additionally, 7 any rates, terms, and conditions involving deductibles, 8 copayments, coinsurance, and any other cost-sharing 9 requirements shall be cumulative for coverage of both mental 10 health conditions and other health or medical conditions under 11 the policy, contract, or plan. 12 b. Coverage required under this subsection shall be as 13 follows: 14 (1) For the treatment of mental illness, coverage shall be 15 for services provided by a licensed mental health professional, 16 as defined in section 228.1, or services provided in a licensed 17 hospital or health facility. 18 (2) For the treatment of alcohol or substance abuse, 19 coverage shall be for services provided by a substance abuse 20 treatment and rehabilitation facility, as licensed by the 21 department of public health pursuant to chapter 125. 22 4. This section applies to the following classes of 23 third-party payment provider policies, contracts, or plans 24 delivered, issued for delivery, continued, or renewed in this 25 state on or after July 1, 2011: 26 a. Individual or group accident and sickness insurance 27 providing coverage on an expense-incurred basis. 28 b. An individual or group hospital or medical service 29 contract issued pursuant to chapter 509, 514, or 514A. 30 c. A plan established pursuant to chapter 509A for public 31 employees. 32 d. An individual or group health maintenance organization 33 contract regulated under chapter 514B. 34 e. Any other entity engaged in the business of insurance, 35 -2- LSB 5514HC (7) 83 av/rj 2/ 4

H.F. _____ risk transfer, or risk retention, which is subject to the 1 jurisdiction of the commissioner of insurance. 2 f. An organized delivery system licensed by the director of 3 public health. 4 5. The division of mental health and disability services of 5 the department of human services and the division of behavioral 6 health of the department of public health shall coordinate with 7 the Iowa department of veterans affairs to maximize access to 8 mental health and substance abuse treatment for veterans. 9 6. This section shall not apply to accident-only, specified 10 disease, short-term hospital or medical, hospital confinement 11 indemnity, credit, dental, vision, Medicare supplement, 12 long-term care, basic hospital and medical-surgical expense 13 coverage as defined by the commissioner of insurance, 14 disability income insurance coverage, coverage issued as a 15 supplement to liability insurance, workers’ compensation or 16 similar insurance, or automobile medical payment insurance. 17 Sec. 3. REPEAL. Section 514C.22, Code 2009, is repealed 18 effective July 1, 2011. 19 Sec. 4. EFFECTIVE DATE. The following provision of this Act 20 takes effect July 1, 2011: 21 1. Section 1 of this Act amending section 135H.3, subsection 22 2. 23 EXPLANATION 24 This bill creates new Code section 514C.26, entitled the 25 “Equality in Heath Care Coverage and Veterans Wellness Act”, 26 and provides that, effective July 1, 2011, a policy, contract, 27 or plan providing for third-party payment or prepayment of 28 health or medical expenses must provide coverage benefits for 29 mental health conditions based on rates, terms, and conditions 30 which are no more restrictive than the rates, terms, and 31 conditions associated with coverage benefits provided for 32 other conditions under the policy, contract, or plan. “Mental 33 health condition” means a condition or disorder involving 34 mental illness or alcohol or substance abuse as defined by 35 -3- LSB 5514HC (7) 83 av/rj 3/ 4

H.F. _____ the commissioner of insurance, by rule, consistent with the 1 diagnostic categories listed in the mental disorders section 2 of the most recent version of the diagnostic and statistical 3 manual of mental disorders of the American psychiatric 4 association. 5 The bill also requires the division of mental health and 6 disability services of the department of human services and 7 the division of behavioral health of the department of public 8 health to coordinate with the Iowa department of veterans 9 affairs to maximize access to mental health and substance abuse 10 treatment for veterans. 11 Code section 514C.22, which currently mandates coverage 12 for certain biologically based mental illnesses, is repealed 13 effective July 1, 2011. 14 Code section 135H.3 is amended to coordinate with new Code 15 section 514C.26, and the repeal of Code section 514C.22, 16 effective July 1, 2011. 17 -4- LSB 5514HC (7) 83 av/rj 4/ 4