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House File 50 - IntroducedA Bill ForAn Act 1relating to insurance coverage for the treatment of
2eating disorders.
3BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. NEW SECTION. 514C.36 Eating disorders —
2coverage.
31. As used in this section, unless the context otherwise
4requires:
5a. “Cost-sharing” means any coverage limit, copayment,
6coinsurance, deductible, or other out-of-pocket expense
7obligation imposed on a covered person by a policy, contract,
8or plan providing for third-party payment or prepayment of
9health or medical expenses.
10b. “Covered person” means a policyholder, subscriber, or
11other person participating in a policy, contract, or plan that
12provides for third-party payment or prepayment of health or
13medical expenses.
14c. “Eating disorder” means pica, rumination disorder,
15avoidant or restrictive food intake disorder, anorexia nervosa,
16bulimia nervosa, binge eating disorder, other specified feeding
17or eating disorder, and any other eating disorder contained
18in the most recent edition of the diagnostic and statistical
19manual of mental disorders as published by the American
20psychiatric association.
21d. “Facility” means an institution providing health care
22services or a health care setting, including but not limited
23to hospitals and other licensed inpatient centers, ambulatory
24surgical or treatment centers, skilled nursing centers,
25residential treatment centers, diagnostic centers, laboratory
26and imaging centers, rehabilitation centers, and other
27therapeutic settings.
28e. “Health care professional” means a physician, a
29psychologist, a psychiatrist, a nutritionist, or other
30health care practitioner licensed, accredited, registered, or
31certified to perform specified health care services consistent
32with state law.
33f. “Health care provider” means a health care professional
34or a facility.
35g. “Health care services” means services for the diagnosis,
-1-1prevention, treatment, cure, or relief of a health condition,
2illness, injury, or disease including services for mental
3health conditions, illnesses, injuries, or diseases. “Health
4care services” also includes dental care services.
5h. “Health carrier” means the same as defined in section
6514J.102.
7i. “Treatment plan” means a plan for the treatment of
8a covered person’s eating disorder developed by a health
9care professional pursuant to a comprehensive evaluation
10or reevaluation performed in consultation with the covered
11person or the covered person’s representative. The plan may
12include but is not limited to cognitive behavioral therapy,
13family-based therapy, group cognitive behavioral therapy,
14nutrition education, prescription drugs, hospitalization, day
15treatment programs, residential treatment programs, and other
16health care services.
172. a. Notwithstanding the uniformity of treatment
18requirements of section 514C.6, a health carrier that offers
19individual, group, or small group contracts, policies, or
20plans in this state that provide for third-party payment or
21prepayment of health or medical expenses shall offer coverage
22for the treatment of eating disorders including all of the
23following:
24(1) Health care services pursuant to a covered person’s
25treatment plan.
26(2) Health care services pursuant to a covered person’s
27treatment plan that are provided to the covered person
28out-of-network or out-of-state if such health care services are
29unavailable in this state and are determined to be medically
30necessary by the covered person’s health care provider.
31b. Coverage required under this section shall not be less
32favorable than coverage a health carrier offers for general
33physical illness.
34c. Cost-sharing requirements imposed for coverage
35required under this section shall not be less favorable than
-2-1cost-sharing requirements imposed by a health carrier for
2general physical illness.
33. a. This section applies to the following classes of
4third-party payment provider contracts, policies, or plans
5delivered, issued for delivery, continued, or renewed in this
6state on or after January 1, 2024:
7(1) Individual or group accident and sickness insurance
8providing coverage on an expense-incurred basis.
9(2) An individual or group hospital or medical service
10contract issued pursuant to chapter 509, 514, or 514A.
11(3) An individual or group health maintenance organization
12contract regulated under chapter 514B.
13(4) A plan established for public employees pursuant to
14chapter 509A.
15(5) The medical assistance program under chapter 249A
16including all managed care organizations acting pursuant to a
17contract with the department of health and human services to
18administer the medical assistance program.
19b. This section shall not apply to accident-only,
20specified disease, short-term hospital or medical, hospital
21confinement indemnity, credit, dental, vision, Medicare
22supplement, long-term care, basic hospital and medical-surgical
23expense coverage as defined by the commissioner, disability
24income insurance coverage, coverage issued as a supplement
25to liability insurance, workers’ compensation or similar
26insurance, or automobile medical payment insurance.
274. The commissioner of insurance shall adopt rules pursuant
28to chapter 17A to administer this section.
29EXPLANATION
30The inclusion of this explanation does not constitute agreement with
31the explanation’s substance by the members of the general assembly.
32This bill relates to insurance coverage for eating
33disorders. “Eating disorder” is defined in the bill as pica,
34rumination disorder, avoidant or restrictive food intake
35disorder, anorexia nervosa, bulimia nervosa, binge eating
-3-1disorder, other specified feeding or eating disorder, and any
2other eating disorder contained in the most recent edition of
3the diagnostic and statistical manual of mental disorders as
4published by the American psychiatric association.
5The bill requires a policy, contract, or plan providing for
6third-party payment or prepayment of health or medical expenses
7to provide coverage for health care services (services)
8pursuant to a covered person’s treatment plan (plan), and
9services pursuant to a covered person’s plan that are provided
10to the covered person out-of-network or out-of-state if such
11services are unavailable in this state and are determined
12to be medically necessary by the covered person’s health
13care provider. “Treatment plan” is defined in the bill
14as a plan for the treatment of a covered person’s eating
15disorder developed by a health care professional pursuant
16to a comprehensive evaluation or reevaluation performed in
17consultation with the covered person or the covered person’s
18representative. The plan may include but is not limited to
19cognitive behavioral therapy, family-based therapy, group
20cognitive behavioral therapy, nutrition education, prescription
21drugs, hospitalization, day treatment programs, residential
22treatment programs, and other health care services.
23The bill applies to third-party payment providers enumerated
24in the bill, including the medical assistance program (program)
25under Code chapter 249A and managed care organizations acting
26pursuant to a contract with the department of health and human
27services to administer the program. The bill specifies the
28types of specialized health-related insurance which are not
29subject to the bill.
30The commissioner of insurance is required to adopt rules to
31administer the bill.
32The bill applies to third-party payment provider contracts,
33policies, or plans delivered, issued for delivery, continued,
34or renewed in this state on or after January 1, 2024.
-4-ko/rn
2eating disorders.
3BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. NEW SECTION. 514C.36 Eating disorders —
2coverage.
31. As used in this section, unless the context otherwise
4requires:
5a. “Cost-sharing” means any coverage limit, copayment,
6coinsurance, deductible, or other out-of-pocket expense
7obligation imposed on a covered person by a policy, contract,
8or plan providing for third-party payment or prepayment of
9health or medical expenses.
10b. “Covered person” means a policyholder, subscriber, or
11other person participating in a policy, contract, or plan that
12provides for third-party payment or prepayment of health or
13medical expenses.
14c. “Eating disorder” means pica, rumination disorder,
15avoidant or restrictive food intake disorder, anorexia nervosa,
16bulimia nervosa, binge eating disorder, other specified feeding
17or eating disorder, and any other eating disorder contained
18in the most recent edition of the diagnostic and statistical
19manual of mental disorders as published by the American
20psychiatric association.
21d. “Facility” means an institution providing health care
22services or a health care setting, including but not limited
23to hospitals and other licensed inpatient centers, ambulatory
24surgical or treatment centers, skilled nursing centers,
25residential treatment centers, diagnostic centers, laboratory
26and imaging centers, rehabilitation centers, and other
27therapeutic settings.
28e. “Health care professional” means a physician, a
29psychologist, a psychiatrist, a nutritionist, or other
30health care practitioner licensed, accredited, registered, or
31certified to perform specified health care services consistent
32with state law.
33f. “Health care provider” means a health care professional
34or a facility.
35g. “Health care services” means services for the diagnosis,
-1-1prevention, treatment, cure, or relief of a health condition,
2illness, injury, or disease including services for mental
3health conditions, illnesses, injuries, or diseases. “Health
4care services” also includes dental care services.
5h. “Health carrier” means the same as defined in section
6514J.102.
7i. “Treatment plan” means a plan for the treatment of
8a covered person’s eating disorder developed by a health
9care professional pursuant to a comprehensive evaluation
10or reevaluation performed in consultation with the covered
11person or the covered person’s representative. The plan may
12include but is not limited to cognitive behavioral therapy,
13family-based therapy, group cognitive behavioral therapy,
14nutrition education, prescription drugs, hospitalization, day
15treatment programs, residential treatment programs, and other
16health care services.
172. a. Notwithstanding the uniformity of treatment
18requirements of section 514C.6, a health carrier that offers
19individual, group, or small group contracts, policies, or
20plans in this state that provide for third-party payment or
21prepayment of health or medical expenses shall offer coverage
22for the treatment of eating disorders including all of the
23following:
24(1) Health care services pursuant to a covered person’s
25treatment plan.
26(2) Health care services pursuant to a covered person’s
27treatment plan that are provided to the covered person
28out-of-network or out-of-state if such health care services are
29unavailable in this state and are determined to be medically
30necessary by the covered person’s health care provider.
31b. Coverage required under this section shall not be less
32favorable than coverage a health carrier offers for general
33physical illness.
34c. Cost-sharing requirements imposed for coverage
35required under this section shall not be less favorable than
-2-1cost-sharing requirements imposed by a health carrier for
2general physical illness.
33. a. This section applies to the following classes of
4third-party payment provider contracts, policies, or plans
5delivered, issued for delivery, continued, or renewed in this
6state on or after January 1, 2024:
7(1) Individual or group accident and sickness insurance
8providing coverage on an expense-incurred basis.
9(2) An individual or group hospital or medical service
10contract issued pursuant to chapter 509, 514, or 514A.
11(3) An individual or group health maintenance organization
12contract regulated under chapter 514B.
13(4) A plan established for public employees pursuant to
14chapter 509A.
15(5) The medical assistance program under chapter 249A
16including all managed care organizations acting pursuant to a
17contract with the department of health and human services to
18administer the medical assistance program.
19b. This section shall not apply to accident-only,
20specified disease, short-term hospital or medical, hospital
21confinement indemnity, credit, dental, vision, Medicare
22supplement, long-term care, basic hospital and medical-surgical
23expense coverage as defined by the commissioner, disability
24income insurance coverage, coverage issued as a supplement
25to liability insurance, workers’ compensation or similar
26insurance, or automobile medical payment insurance.
274. The commissioner of insurance shall adopt rules pursuant
28to chapter 17A to administer this section.
29EXPLANATION
30The inclusion of this explanation does not constitute agreement with
31the explanation’s substance by the members of the general assembly.
32This bill relates to insurance coverage for eating
33disorders. “Eating disorder” is defined in the bill as pica,
34rumination disorder, avoidant or restrictive food intake
35disorder, anorexia nervosa, bulimia nervosa, binge eating
-3-1disorder, other specified feeding or eating disorder, and any
2other eating disorder contained in the most recent edition of
3the diagnostic and statistical manual of mental disorders as
4published by the American psychiatric association.
5The bill requires a policy, contract, or plan providing for
6third-party payment or prepayment of health or medical expenses
7to provide coverage for health care services (services)
8pursuant to a covered person’s treatment plan (plan), and
9services pursuant to a covered person’s plan that are provided
10to the covered person out-of-network or out-of-state if such
11services are unavailable in this state and are determined
12to be medically necessary by the covered person’s health
13care provider. “Treatment plan” is defined in the bill
14as a plan for the treatment of a covered person’s eating
15disorder developed by a health care professional pursuant
16to a comprehensive evaluation or reevaluation performed in
17consultation with the covered person or the covered person’s
18representative. The plan may include but is not limited to
19cognitive behavioral therapy, family-based therapy, group
20cognitive behavioral therapy, nutrition education, prescription
21drugs, hospitalization, day treatment programs, residential
22treatment programs, and other health care services.
23The bill applies to third-party payment providers enumerated
24in the bill, including the medical assistance program (program)
25under Code chapter 249A and managed care organizations acting
26pursuant to a contract with the department of health and human
27services to administer the program. The bill specifies the
28types of specialized health-related insurance which are not
29subject to the bill.
30The commissioner of insurance is required to adopt rules to
31administer the bill.
32The bill applies to third-party payment provider contracts,
33policies, or plans delivered, issued for delivery, continued,
34or renewed in this state on or after January 1, 2024.
-4-ko/rn