Bill Text: IA HF93 | 2011-2012 | 84th General Assembly | Introduced
Bill Title: A bill for an act relating to third-party payment of health care coverage costs for mental health conditions, including alcohol or substance abuse treatment services, creation of a mental health insurance advisory committee, and including applicability provisions and a repeal.
Spectrum: Partisan Bill (Democrat 18-0)
Status: (Introduced - Dead) 2011-12-31 - END OF 2011 ACTIONS [HF93 Detail]
Download: Iowa-2011-HF93-Introduced.html
House
File
93
-
Introduced
HOUSE
FILE
93
BY
M.
SMITH
,
PETERSEN
,
ABDUL-SAMAD
,
HUNTER
,
LENSING
,
RUNNING-MARQUARDT
,
WESSEL-KROESCHELL
,
MASCHER
,
OLDSON
,
HEDDENS
,
ISENHART
,
HALL
,
KEARNS
,
KELLEY
,
GASKILL
,
HANSON
,
and
STECKMAN
A
BILL
FOR
An
Act
relating
to
third-party
payment
of
health
care
coverage
1
costs
for
mental
health
conditions,
including
alcohol
2
or
substance
abuse
treatment
services,
creation
of
a
3
mental
health
insurance
advisory
committee,
and
including
4
applicability
provisions
and
a
repeal.
5
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
6
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Section
1.
NEW
SECTION
.
514C.29
Mandated
coverage
for
1
mental
health
conditions
——
mental
health
insurance
advisory
2
committee.
3
1.
For
purposes
of
this
section,
unless
the
context
4
otherwise
requires:
5
a.
“Mental
health
condition”
means
a
condition
or
disorder
6
involving
mental
illness
or
alcohol
or
substance
abuse
as
7
defined
by
the
commissioner
of
insurance,
by
rule,
consistent
8
with
conditions
or
disorders
that
fall
under
any
of
the
9
diagnostic
categories
listed
in
the
mental
disorders
section
of
10
the
international
classification
of
diseases,
as
periodically
11
revised.
The
commissioner
may
adopt
the
lists
or
definitions
12
provided
in
such
classification
of
disease
by
reference.
13
b.
“Rates,
terms,
and
conditions”
means
any
lifetime
14
payment
limits,
deductibles,
copayments,
coinsurance,
and
any
15
other
cost-sharing
requirements,
out-of-pocket
limits,
visit
16
limitations,
and
any
other
financial
component
of
benefits
17
coverage
that
affects
the
covered
individual.
18
2.
a.
Notwithstanding
section
514C.6,
a
policy,
contract,
19
or
plan
providing
for
third-party
payment
or
prepayment
of
20
health
or
medical
expenses
shall
provide
coverage
benefits
for
21
mental
health
conditions
based
on
rates,
terms,
and
conditions
22
which
are
no
more
restrictive
than
the
rates,
terms,
and
23
conditions
for
coverage
benefits
provided
for
other
health
24
or
medical
conditions
under
the
policy,
contract,
or
plan.
25
Additionally,
any
rates,
terms,
and
conditions
involving
26
deductibles,
copayments,
coinsurance,
and
any
other
cost-
27
sharing
requirements
shall
be
cumulative
for
coverage
of
both
28
mental
health
conditions
and
other
health
or
medical
conditions
29
under
the
policy,
contract,
or
plan.
30
b.
Coverage
required
under
this
subsection
shall
be
as
31
follows:
32
(1)
For
the
treatment
of
mental
illness,
coverage
shall
be
33
for
services
provided
by
a
licensed
mental
health
professional
34
or
services
provided
in
a
licensed
hospital
or
health
facility.
35
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(2)
For
the
treatment
of
alcohol
or
substance
abuse,
1
coverage
shall
be
for
services
provided
by
a
substance
2
abuse
counselor,
as
approved
by
the
department
of
human
3
services;
a
licensed
health
facility
providing
a
program
for
4
the
treatment
of
alcohol
or
substance
abuse
approved
by
the
5
department
of
human
services;
or
a
substance
abuse
treatment
6
and
rehabilitation
facility,
as
licensed
by
the
department
of
7
public
health
pursuant
to
chapter
125.
8
3.
This
section
applies
to
the
following
classes
of
9
third-party
payment
provider
contracts,
policies,
or
plans
10
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
11
state
on
or
after
January
1,
2012:
12
a.
Individual
or
group
accident
and
sickness
insurance
13
providing
coverage
on
an
expense-incurred
basis.
14
b.
An
individual
or
group
hospital
or
medical
service
15
contract
issued
pursuant
to
chapter
509,
514,
or
514A.
16
c.
A
plan
established
pursuant
to
chapter
509A
for
public
17
employees.
18
d.
An
individual
or
group
health
maintenance
organization
19
contract
regulated
under
chapter
514B.
20
e.
An
individual
or
group
Medicare
supplemental
policy,
21
unless
coverage
pursuant
to
such
policy
is
preempted
by
federal
22
law.
23
f.
Any
other
entity
engaged
in
the
business
of
insurance,
24
risk
transfer,
or
risk
retention,
which
is
subject
to
the
25
jurisdiction
of
the
commissioner.
26
g.
An
organized
delivery
system
licensed
by
the
director
of
27
public
health.
28
4.
The
commissioner
shall
adopt
rules
to
administer
this
29
section
after
consultation
with
the
mental
health
insurance
30
advisory
committee.
31
a.
The
commissioner
shall
appoint
members
to
a
mental
32
health
insurance
advisory
committee.
Members
shall
include
all
33
sectors
of
society
impacted
by
issues
associated
with
coverage
34
of
mental
health
treatment
by
third-party
payors
including
35
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93
but
not
limited
to
representatives
of
the
insurance
industry,
1
small
and
large
employers,
employee
representatives
including
2
labor,
individual
consumers,
health
care
providers,
and
other
3
groups
and
individuals
that
may
be
identified
by
the
insurance
4
division
of
the
department
of
commerce.
5
b.
The
committee
shall
meet
upon
the
request
of
the
6
commissioner
to
review
rules
proposed
under
this
section
by
the
7
commissioner,
and
to
make
suggestions
as
appropriate.
8
Sec.
2.
REPEAL.
Section
514C.22,
Code
2011,
is
repealed
9
effective
January
1,
2012.
10
EXPLANATION
11
This
bill
creates
new
Code
section
514C.29
and
provides
that
12
a
policy,
contract,
or
plan
providing
for
third-party
payment
13
or
prepayment
of
health
or
medical
expenses
must
provide
14
coverage
benefits
for
mental
health
conditions
based
on
rates,
15
terms,
and
conditions
which
are
no
more
restrictive
than
the
16
rates,
terms,
and
conditions
associated
with
coverage
benefits,
17
provided
for
other
conditions
under
the
policy,
contract,
or
18
plan.
“Mental
health
conditions”
are
to
be
defined,
by
rule,
19
by
the
commissioner
of
insurance
consistent
with
conditions
20
or
disorders
involving
mental
illness
or
alcohol
or
substance
21
abuse
that
fall
under
any
of
the
diagnostic
categories
22
listed
in
the
mental
disorders
section
of
the
international
23
classification
of
diseases,
as
periodically
updated.
24
The
bill
also
requires
the
commissioner
of
insurance
25
to
adopt
rules
to
administer
the
new
Code
section,
after
26
consultation
with
a
new
mental
health
insurance
advisory
27
committee,
whose
members
are
appointed
by
the
commissioner
from
28
business,
consumer,
and
health
groups.
29
The
bill
applies
to
third-party
payment
provider
contracts,
30
policies,
or
plans
delivered,
issued
forth
for
delivery,
31
continued,
or
renewed
in
this
state
on
or
after
January
1,
32
2012.
33
Code
section
514C.22,
which
currently
mandates
coverage
34
for
certain
biologically
based
mental
illnesses,
is
repealed
35
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