HF 443 (LSB 1723YH (2) 91)

HOUSE FILE 443

BY  A. MEYER

A BILL FOR

An Act relating to health insurance coverage for assertive community treatment services.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  514C.37  Assertive community treatment services —— coverage.
   1.  As used in this section, unless the context otherwise requires:
   a.  “Covered person” means a policyholder, subscriber, enrollee, or other individual participating in a health benefit plan.
   b.  “Dependent” means a dependent of a covered person.
   c.  “Health benefit plan” means the same as defined in section 510B.1.
   2.  Notwithstanding the uniformity of treatment requirements of section 514C.6, a health benefit plan shall provide coverage for assertive community treatment services for a dependent who receives assertive community treatment services from an assertive community treatment provider that is enrolled in, and in good standing with, the medical assistance program under chapter 249A.
   3.  a.  This section applies to the following classes of third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2026:
   (1)  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   (2)  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   (3)  An individual or group health maintenance organization contract regulated under chapter 514B.
   (4)  A plan established for public employees pursuant to chapter 509A.
   b.  This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner of insurance, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
   4.  The commissioner of insurance may adopt rules pursuant to chapter 17A to administer this section.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to insurance coverage for assertive community treatment services.
   The bill requires a health benefit plan to provide coverage for assertive community treatment services for a dependent, as defined in the bill, who receives services from an assertive community treatment provider that is enrolled in, and in good standing with, the medical assistance program under Code chapter 249A.
   The bill applies to third-party payment providers enumerated in the bill. The bill specifies the types of specialized health-related insurance which are not subject to the bill.
   The commissioner of insurance may adopt rules to administer the bill.