House Bill 0041e3

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                                            HB 41, Third Engrossed



  1                      A bill to be entitled

  2         An act relating to health insurance; providing

  3         a short title; amending s. 627.668, F.S.;

  4         providing that the current requirement for

  5         group insurers to offer coverage for mental

  6         health conditions does not apply to serious

  7         mental illness; creating s. 627.6681, F.S.;

  8         requiring group health insurers and health

  9         maintenance organizations to provide coverage

10         for serious mental illness; requiring benefits

11         to be the same as for physical illness

12         generally; requiring the health benefit plan

13         committee to consider and recommend

14         modifications to standard, basic, and limited

15         health benefit plans; requiring rate filings;

16         providing a definition; providing rulemaking

17         authority; authorizing an insurer to establish

18         certain compliance functions; amending ss.

19         627.6472, 627.6515, 641.31, F.S., relating to

20         exclusive provider organizations, out-of-state

21         groups, and health maintenance contracts;

22         providing requirements for coverage compliance;

23         providing an appropriation; providing a

24         description of state interest; providing an

25         effective date.

26

27  Be It Enacted by the Legislature of the State of Florida:

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29         Section 1.  This act may be cited as the "Dianne Steele

30  Mental Illness Insurance Parity Act."

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                                            HB 41, Third Engrossed



  1         Section 2.  Section 627.668, Florida Statutes, is

  2  amended to read:

  3         627.668  Optional coverage for mental and nervous

  4  disorders required; exception.--

  5         (1)  Every insurer, health maintenance organization,

  6  and nonprofit hospital and medical service plan corporation

  7  transacting group health insurance or providing prepaid health

  8  care in this state shall make available to the policyholder as

  9  part of the application, for an appropriate additional premium

10  under a group hospital and medical expense-incurred insurance

11  policy, under a group prepaid health care contract, and under

12  a group hospital and medical service plan contract, the

13  benefits or level of benefits specified in subsection (2) for

14  the necessary care and treatment of mental and nervous

15  disorders, as defined in the standard nomenclature of the

16  American Psychiatric Association, except this section shall

17  not apply to coverage for serious mental illness as defined in

18  s. 627.6681.  The coverage required in this section shall be

19  subject to the right of the applicant for a group policy or

20  contract to select any alternative benefits or level of

21  benefits as may be offered by the insurer, health maintenance

22  organization, or service plan corporation provided that, if

23  alternate inpatient, outpatient, or partial hospitalization

24  benefits are selected, such benefits shall not be less than

25  the level of benefits required under paragraph (2)(a),

26  paragraph (2)(b), or paragraph (2)(c), respectively.

27         (2)  Under group policies or contracts, inpatient

28  hospital benefits, partial hospitalization benefits, and

29  outpatient benefits provided pursuant to this section,

30  consisting of durational limits, dollar amounts, deductibles,

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                                            HB 41, Third Engrossed



  1  and coinsurance factors shall not be less favorable than for

  2  physical illness generally, except that:

  3         (a)  Inpatient benefits may be limited to not less than

  4  30 days per benefit year as defined in the policy or contract.

  5  If inpatient hospital benefits are provided beyond 30 days per

  6  benefit year, the durational limits, dollar amounts, and

  7  coinsurance factors thereto need not be the same as applicable

  8  to physical illness generally.

  9         (b)  Outpatient benefits may be limited to $1,000 for

10  consultations with a licensed physician, a psychologist

11  licensed pursuant to chapter 490, a mental health counselor

12  licensed pursuant to chapter 491, a marriage and family

13  therapist licensed pursuant to chapter 491, and a clinical

14  social worker licensed pursuant to chapter 491.  If benefits

15  are provided beyond the $1,000 per benefit year, the

16  durational limits, dollar amounts, and coinsurance factors

17  thereof need not be the same as applicable to physical illness

18  generally.

19         (c)  Partial hospitalization benefits shall be provided

20  under the direction of a licensed physician.  For purposes of

21  this part, the term "partial hospitalization services" is

22  defined as those services offered by a program accredited by

23  the Joint Commission on Accreditation of Hospitals (JCAH) or

24  in compliance with equivalent standards. Alcohol

25  rehabilitation programs accredited by the Joint Commission on

26  Accreditation of Hospitals or approved by the state and

27  licensed drug abuse rehabilitation programs shall also be

28  qualified providers under this section.  In any benefit year,

29  if partial hospitalization services or a combination of

30  inpatient and partial hospitalization are utilized, the total

31  benefits paid for all such services shall not exceed the cost


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                                            HB 41, Third Engrossed



  1  of 30 days of inpatient hospitalization for psychiatric

  2  services, including physician fees, which prevail in the

  3  community in which the partial hospitalization services are

  4  rendered.  If partial hospitalization services benefits are

  5  provided beyond the limits set forth in this paragraph, the

  6  durational limits, dollar amounts, and coinsurance factors

  7  thereof need not be the same as those applicable to physical

  8  illness generally.

  9         (3)  Insurers providing coverage pursuant to this

10  section and s. 627.6681 must maintain strict confidentiality

11  regarding psychiatric and psychotherapeutic records submitted

12  to an insurer for the purpose of reviewing a claim for

13  benefits payable under this section.  These records submitted

14  to an insurer are subject to the limitations of s. 455.241,

15  relating to the furnishing of patient records.

16         Section 3.  Section 627.6681, Florida Statutes, is

17  created to read:

18         627.6681  Coverage for serious mental illness

19  required.--

20         (1)  Every insurer and health maintenance organization

21  transacting group health insurance or providing prepaid health

22  care in this state shall provide as part of such insurance or

23  health care under a group hospital and medical

24  expense-incurred insurance policy, under a group prepaid

25  health care contract, or under a group health maintenance

26  organization contract, coverage for the treatment of serious

27  mental illness, which treatment is determined to be medically

28  necessary. When a diagnosis of serious mental illness is

29  accompanied by substance abuse, treatment for the patient who

30  is dually diagnosed shall include, but not be limited to,

31  treatment for substance abuse.


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                                            HB 41, Third Engrossed



  1         (2)  Under group policies or contracts, inpatient

  2  hospital benefits, partial hospitalization benefits, and

  3  outpatient benefits consisting of durational limits, dollar

  4  amounts, deductibles, and coinsurance factors shall be the

  5  same for serious mental illness as for physical illness

  6  generally.

  7         (3)  The standard, basic, and limited health benefit

  8  plan committee, duly appointed in the manner provided in s.

  9  627.6699(12)(a)1., shall consider the modification of the

10  standard, basic, and limited health benefit plans developed

11  pursuant to s. 627.6699(12) to include coverage for serious

12  mental illness as prescribed in this section. The committee

13  shall submit any recommended modifications to the department

14  for approval.

15         (4)  With respect to providing the coverage required

16  under this section, the insurer or health maintenance

17  organization must file a rate factor that sets forth in detail

18  in any rate filing under s. 627.410 the portion of any

19  increase in rates which is attributable to the coverage. If

20  the factor indicates an increase that exceeds 2.5 percent, the

21  insurer or health maintenance organization may adjust the

22  deductibles, coinsurance, or limits that apply to coverage

23  required under this section to limit the percentage increase

24  to 2.5 percent with respect to any one calendar year and shall

25  demonstrate this adjustment in the filing.

26         (5)(a)  As used in this section, the term "serious

27  mental illness" means any mental illness that is recognized in

28  the edition of relevant manuals of the American Psychiatric

29  Association or by the International Classification of Diseases

30  in effect on October 1, 1998, and affirmed by medical science

31  as caused by biological disorder of the brain, and that


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                                            HB 41, Third Engrossed



  1  substantially limits the life activities of the patient.  The

  2  term includes schizophrenia, autism, schizoaffective

  3  disorders, anxiety and panic disorders, bipolar affective

  4  disorders, major depression, and obsessive compulsive

  5  disorder.

  6         (b)  The department may adopt by rule a subsequent

  7  edition of the manuals cited in paragraph (a) if a subsequent

  8  edition is substantially similar to the edition in effect on

  9  October 1, 1998. The department may adopt rules to implement

10  this section, including specifications for ratemaking and

11  information for calculating rates necessary to determine

12  compliance with ss. 627.410, 627.411, and 627.6681.

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14  An insurer may require that an insured who seeks covered

15  services for a serious mental illness be referred for such

16  services by a designated health care provider responsible for

17  coordinating the serious mental illness treatment of the

18  insurer's subscribers.

19         Section 4.  Subsection (17) is added to section

20  627.6472, Florida Statutes, to read:

21         627.6472  Exclusive provider organizations.--

22         (17)  Each exclusive provider organization that offers

23  a group plan within this state must comply with s. 627.6681.

24         Section 5.  Subsection (8) is added to section

25  627.6515, Florida Statutes, to read:

26         627.6515  Out-of-state groups.--

27         (8)  Each group, blanket, and franchise health

28  insurance policy that offers a group plan within this state

29  must comply with s. 627.6681.

30         Section 6.  Subsection (34) is added to section 641.31,

31  Florida Statutes, to read:


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                                            HB 41, Third Engrossed



  1         641.31  Health maintenance contracts.--

  2         (34)  Each health maintenance organization that offers

  3  a group plan within this state must comply with s. 627.6681.

  4         Section 7.  There is hereby appropriated to the

  5  Department of Insurance from the Insurance Commissioner's

  6  Regulatory Trust Fund for fiscal year 1998-1999 one full-time

  7  equivalent position and $38,288 to implement the provisions of

  8  this act.

  9         Section 8.  The provisions of this bill fulfill an

10  important state interest in that they promote the relief and

11  alleviation of health or medical problems that affect

12  significant portions of the state's population.  The bill, in

13  requiring insurance coverage, should facilitate closer

14  scrutiny of the treatment of these conditions, resulting in

15  more cost-efficient and effective treatment of such

16  conditions.  By improving the overall level and quality of

17  health care, the bill will have the effect of reducing total

18  costs of medical plans under which treatment is provided for

19  these conditions, thereby reducing public medical assistance

20  benefits as well as outlays for persons covered under all

21  medical plans.

22         Section 9.  This act shall take effect October 1 of the

23  year in which enacted, and shall apply to any policy issued,

24  written, or renewed in this state on or after such date.

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