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1999 SESSION

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SB 430 Health insurance; mental health coverage.

Introduced by: R. Edward Houck | all patrons    ...    notes | add to my profiles | history

SUMMARY AS ENACTED WITH GOVERNOR'S RECOMMENDATION:

Accident and sickness insurance; mental health coverage. Requires the state health care plans, health insurers, health services plans and health maintenance organizations to provide coverage for biologically based mental illness. The bill requires that coverage for biologically based mental illness be no different from coverage for other illnesses or conditions for the purpose of determining deductibles, benefit year or lifetime durational limits, lifetime episodes or treatment limits, copayment and coinsurance factors, and benefit year maximums for deductibles and copayment and coinsurance factors. The bill does not prevent the undertaking of usual and customary procedures to determine the appropriateness and medical necessity for the treatment of mental disorders, so long as such procedures are made in the same manner as the determinations made for the treatment of any other illness or condition. The bill is not applicable to policies, contracts or plans covering employee groups having less than 25 employees.

“Biologically based mental illness” is any mental or nervous condition caused by a biological disorder of the brain that results in a clinically significant or psychological syndrome or a pattern substantially limiting the person’s functioning, including, but not limited to, schizophrenia, schizoaffective disorder, attention deficit hyperactivity disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, panic disorder, autism, psychotic disorder, and drug and alcohol addiction.

The provisions of the bill become effective July 1, 2000, and expire on July 1, 2004.

The bill also requires the Department of Personnel and Training to collect data and perform analyses in order to determine the effect of the bill’s provisions on claims experience and costs. The Department of Personnel and Training must submit written reports of its findings to the Governor, the General Assembly, and the House Appropriations and Senate Finance Committees, no later than December 1, 2001, December 1, 2002, and December 1, 2003. The Special Advisory Commission on Mandated Health Insurance Benefits is directed to collect data, perform studies and convene public hearings to determine the effect of the bill’s provisions on claim experience and costs. The Special Advisory Commission on Mandated Health Insurance Benefits must submit written reports of its findings to the Governor and the General Assembly no later than July 1, 2001, December 1, 2002, and December 1, 2003.

SUMMARY AS PASSED SENATE:

Accident and sickness insurance; mental health coverage. Requires the state health care plans, health insurers, health services plans and health maintenance organizations to provide coverage for biologically-based mental illness. The bill requires that coverage for biologically-based mental illness be no different from coverage for other illnesses or conditions for the purpose of determining deductibles, benefit year or lifetime durational limits, lifetime episodes or treatment limits, copayment and coinsurance factors, and benefit year maximums for deductibles and copayment and coinsurance factors. The bill does not prevent the undertaking of usual and customary procedures to determine the appropriateness and medical necessity for the treatment of mental disorders, so long as such procedures are made in the same manner as the determinations made for the treatment of any other illness or condition.

“Biologically-based mental illness” is any mental or nervous condition caused by a biological disorder of the brain that results in a clinically significant or psychological syndrome or a pattern substantially limiting the person’s functioning, including, but not limited to, attention deficit hyperactivity disorder, bipolar disorder, dissociative disorder, major depressive disorder, obsessive-compulsive disorder, panic disorder, pervasive development disorder or autism, post-traumatic stress disorder, psychotic disorder, serious emotional disorders in children and substance abuse disorder.

The provisions of the bill become effective July 1, 2000, and expire on July 1, 2004.

The bill also requires the Department of Personnel and Training to collect data and perform analysis in order to determine the effect of the bill’s provisions on claims experience and costs. The Department of Personnel and Training must submit written reports of their findings to the Governor, the General Assembly, and the House Appropriations and Senate Finance Committees no later than December 1, 2001, December 1, 2002 and December 1, 2003. The Special Advisory Commission on Mandated Health Insurance Benefits is directed to collect data, perform studies and convene public hearings to determine the effect of the bill’s provisions on claim experience and costs. The Special Advisory Commission on Mandated Health Insurance Benefits must submit written reports of their findings to the Governor and the General Assembly no later than July 1, 2001, December 1, 2002, and December 1, 2003.

SUMMARY AS INTRODUCED:

Accident and sickness insurance; mental health coverage. Requires health insurers, health services plans and health maintenance organizations to provide benefits for inpatient, partial hospitalization, medication management and outpatient treatment of mental disorders that are as favorable as the benefits for any other illness, condition, or disorder that is covered by the policy or contract. "Mental disorders" are all medically recognized mental illnesses, as defined by the Diagnostic and Statistical Manual, Fourth Edition, as updated from time to time. In addition to requiring parity in benefits, the bill also requires that coverage for mental disorders be no different from coverage for other illnesses or conditions for the purpose of determining deductibles, benefit year or lifetime durational limits, lifetime episodes or treatment limits, copayment and coinsurance factors, and benefit year maximums for deductibles and copayment and coinsurance factors. The bill does not prevent the undertaking of usual and customary procedures to determine the appropriateness and medical necessity for the treatment of mental disorders, so long as such procedures are made in the same manner as the determinations made for the treatment of any other illness or condition.