Bill Text: FL S0182 | 2010 | Regular Session | Introduced

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Bill Title: Coverage for Mental and Nervous Disorders [CPSC]

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2010-04-30 - Died in Committee on General Government Appropriations [S0182 Detail]

Download: Florida-2010-S0182-Introduced.html

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Florida Senate - 2010                                     SB 182 
 
By Senator Crist 
12-00103A-10                                           2010182__ 
1                        A bill to be entitled 
2         An act relating to coverage for mental and nervous 
3         disorders; amending s. 627.668, F.S.; revising 
4         requirements and limitations for optional coverage for 
5         mental and nervous disorders; specifying 
6         nonapplication under certain circumstances; amending 
7         s. 627.6675, F.S.; conforming a cross-reference; 
8         repealing s. 627.669, F.S., relating to optional 
9         coverage required for substance abuse impaired 
10         persons; providing for application; providing an 
11         effective date. 
12 
13  Be It Enacted by the Legislature of the State of Florida: 
14 
15         Section 1. Section 627.668, Florida Statutes, is amended to 
16  read: 
17         627.668 Optional coverage for mental and nervous disorders 
18  required; exception.— 
19         (1) Every insurer, health maintenance organization, and 
20  nonprofit hospital and medical service plan corporation 
21  transacting group health insurance or providing prepaid health 
22  care in this state under a group hospital and medical expense 
23  incurred insurance policy, a group prepaid health care contract, 
24  or a group hospital and medical service plan contract shall make 
25  available to the policyholder as part of the application, for an 
26  appropriate additional premium under a group hospital and 
27  medical expense-incurred insurance policy, under a group prepaid 
28  health care contract, and under a group hospital and medical 
29  service plan contract, the benefits or level of benefits 
30  specified in subsections subsection (2) and (3) for the 
31  necessary care and treatment of mental and nervous disorders, as 
32  defined in the most recent edition of the Diagnostic and 
33  Statistical Manual of Mental Disorders published by standard 
34  nomenclature of the American Psychiatric Association. This 
35  requirement is, subject to the right of the applicant for a 
36  group policy or contract to select any alternative benefits or 
37  level of benefits as may be offered by the insurer, health 
38  maintenance organization, or service plan corporation. provided 
39  that, If alternate inpatient, outpatient, or partial 
40  hospitalization benefits are selected, such benefits shall not 
41  be less than the level of benefits required under subsections 
42  (2) and (3) paragraph (2)(a), paragraph (2)(b), or paragraph 
43  (2)(c), respectively. With respect to the state group insurance 
44  program, the term “policyholder” means the State of Florida. 
45         (2) Under group policies or contracts, inpatient hospital 
46  benefits, partial hospitalization benefits, and outpatient 
47  benefits consisting of durational limits, dollar amounts, 
48  deductibles, and coinsurance factors shall not be less favorable 
49  for the necessary care and treatment of schizophrenia and 
50  psychotic disorders, mood disorders, anxiety disorders, 
51  substance abuse disorders, eating disorders, and childhood 
52  ADD/ADHD than for physical illness generally. 
53         (3)(2) Under group policies or contracts, Inpatient 
54  hospital benefits, partial hospitalization benefits, and 
55  outpatient benefits for mental health disorders not listed in 
56  subsection (2) consisting of durational limits, dollar amounts, 
57  deductibles, and coinsurance factors shall not be less favorable 
58  than for physical illness generally, except that: 
59         (a) Inpatient benefits may be limited to not less than 45 
60  30 days per benefit year as defined in the policy or contract. 
61  If inpatient hospital benefits are provided beyond 45 30 days 
62  per benefit year, the durational limits, dollar amounts, and 
63  coinsurance factors thereto need not be the same as applicable 
64  to physical illness generally. 
65         (b) Outpatient benefits may be limited to 60 visits per 
66  benefit year $1,000 for consultations with a licensed physician, 
67  a psychologist licensed pursuant to chapter 490, a mental health 
68  counselor licensed pursuant to chapter 491, a marriage and 
69  family therapist licensed pursuant to chapter 491, and a 
70  clinical social worker licensed pursuant to chapter 491. If 
71  benefits are provided beyond the 60 visits $1,000 per benefit 
72  year, the durational limits, dollar amounts, and coinsurance 
73  factors thereof need not be the same as applicable to physical 
74  illness generally. 
75         (c) Partial hospitalization benefits shall be provided 
76  under the direction of a licensed physician. For purposes of 
77  this part, the term “partial hospitalization services” is 
78  defined as those services offered by a program accredited by the 
79  Joint Commission on Accreditation of Hospitals (JCAH) or in 
80  compliance with equivalent standards. Alcohol rehabilitation 
81  programs accredited by the Joint Commission on Accreditation of 
82  Hospitals or approved by the state and licensed drug abuse 
83  rehabilitation programs are shall also be qualified providers 
84  under this section. In any benefit year, if partial 
85  hospitalization services or a combination of inpatient and 
86  partial hospitalization are utilized, the total benefits paid 
87  for all such services shall not exceed the cost of 45 30 days of 
88  inpatient hospitalization for psychiatric services, including 
89  physician fees, which prevail in the community in which the 
90  partial hospitalization services are rendered. If partial 
91  hospitalization services benefits are provided beyond the limits 
92  set forth in this paragraph, the durational limits, dollar 
93  amounts, and coinsurance factors thereof need not be the same as 
94  those applicable to physical illness generally. 
95         (4) In order to reduce service costs and utilization 
96  without compromising quality of care, the insurer or health 
97  maintenance organization that provides benefits under this 
98  section may impose appropriate financial incentives, peer 
99  review, utilization requirements, and other methods used for the 
100  management of benefits provided for other medical conditions. 
101         (5)(3) Insurers must maintain strict confidentiality 
102  regarding psychiatric and psychotherapeutic records submitted to 
103  an insurer for the purpose of reviewing a claim for benefits 
104  payable under this section. These records submitted to an 
105  insurer are subject to the limitations of s. 456.057, relating 
106  to the furnishing of patient records. 
107         (6) This section does not apply with respect to a group 
108  health plan, or health insurance coverage offered in connection 
109  with a group health plan, if the application of this section to 
110  such plan or coverage results in an increase of more than 2 
111  percent in the cost of such coverage, as determined and 
112  certified by an independent actuary to the Office of Insurance 
113  Regulation. 
114         Section 2. Paragraph (b) of subsection (8) of section 
115  627.6675, Florida Statutes, is amended to read: 
116         627.6675 Conversion on termination of eligibility.—Subject 
117  to all of the provisions of this section, a group policy 
118  delivered or issued for delivery in this state by an insurer or 
119  nonprofit health care services plan that provides, on an 
120  expense-incurred basis, hospital, surgical, or major medical 
121  expense insurance, or any combination of these coverages, shall 
122  provide that an employee or member whose insurance under the 
123  group policy has been terminated for any reason, including 
124  discontinuance of the group policy in its entirety or with 
125  respect to an insured class, and who has been continuously 
126  insured under the group policy, and under any group policy 
127  providing similar benefits that the terminated group policy 
128  replaced, for at least 3 months immediately prior to 
129  termination, shall be entitled to have issued to him or her by 
130  the insurer a policy or certificate of health insurance, 
131  referred to in this section as a “converted policy.” A group 
132  insurer may meet the requirements of this section by contracting 
133  with another insurer, authorized in this state, to issue an 
134  individual converted policy, which policy has been approved by 
135  the office under s. 627.410. An employee or member shall not be 
136  entitled to a converted policy if termination of his or her 
137  insurance under the group policy occurred because he or she 
138  failed to pay any required contribution, or because any 
139  discontinued group coverage was replaced by similar group 
140  coverage within 31 days after discontinuance. 
141         (8) BENEFITS OFFERED.— 
142         (b) An insurer shall offer the benefits specified in s. 
143  627.668 and the benefits specified in s. 627.669 if those 
144  benefits were provided in the group plan. 
145         Section 3. Section 627.669, Florida Statutes, is repealed. 
146         Section 4. This act shall take effect January 1, 2011, and 
147  applies to policies and contracts issued or renewed on or after 
148  that date.