Senate Bill sb1834
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Florida Senate - 2007 SB 1834
By Senator Jones
13-634A-07 See HB 291
1 A bill to be entitled
2 An act relating to coverage for mental and
3 nervous disorders; amending s. 627.668, F.S.;
4 revising requirements for optional coverage for
5 mental and nervous disorders; revising certain
6 benefits limitations; providing an options
7 application requirement; providing an effective
8 date.
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10 Be It Enacted by the Legislature of the State of Florida:
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12 Section 1. Section 627.668, Florida Statutes, is
13 amended to read:
14 627.668 Optional coverage for mental and nervous
15 disorders required; exception.--
16 (1) Every insurer, health maintenance organization,
17 and nonprofit hospital and medical service plan corporation
18 transacting group health insurance or providing prepaid health
19 care in this state shall make available to the policyholder as
20 part of the application, for an appropriate additional premium
21 under a group hospital and medical expense-incurred insurance
22 policy, under a group prepaid health care contract, and under
23 a group hospital and medical service plan contract, the
24 benefits or level of benefits specified in subsection (2) for
25 all diagnostic categories of mental health conditions listed
26 in the most recent edition of the Diagnostic and Statistical
27 Manual of Mental Disorders, published by the American
28 Psychiatric Association, and as listed in the mental and
29 behavioral disorders section of the current International
30 Classification of Diseases, to include schizophrenia,
31 schizophrenia-form disorders, schizo-affective disorders,
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CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2007 SB 1834
13-634A-07 See HB 291
1 paranoid and other psychotic disorders, bipolar disorders,
2 panic disorders, obsessive-compulsive disorders, major
3 depressive disorders, anxiety disorders, mood disorders,
4 pervasive development disorders or autism, depression in
5 childhood and adolescence, personality disorders, paraphilias,
6 attention deficit and disruptive behavior disorders, tic
7 disorders, eating disorders including bulimia and anorexia,
8 Asperger's disorder, intermittent explosive disorder,
9 posttraumatic stress disorder, psychosis not otherwise
10 specified (NOS) when diagnosed in a child under 17 years of
11 age, Rett's disorder, Tourette's disorder, delirium, and
12 dementia the necessary care and treatment of mental and
13 nervous disorders, as defined in the standard nomenclature of
14 the American Psychiatric Association, subject to the right of
15 the applicant for a group policy or contract to select any
16 alternative benefits or level of benefits as may be offered by
17 the insurer, health maintenance organization, or service plan
18 corporation provided that, if alternate inpatient, outpatient,
19 or partial hospitalization benefits are selected, such
20 benefits shall not be less than the level of benefits required
21 under subsection paragraph (2)(a), paragraph (2)(b), or
22 paragraph (2)(c), respectively.
23 (2) Under group policies or contracts, inpatient
24 hospital benefits, partial hospitalization benefits, and
25 outpatient benefits consisting of durational limits, dollar
26 amounts, deductibles, and coinsurance factors may not be more
27 restrictive than the treatment limitations and cost-sharing
28 requirements under the plan which are applicable to other
29 disease, illnesses, and medical conditions. shall not be less
30 favorable than for physical illness generally, except that:
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CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2007 SB 1834
13-634A-07 See HB 291
1 (a) Inpatient benefits may be limited to not less than
2 30 days per benefit year as defined in the policy or contract.
3 If inpatient hospital benefits are provided beyond 30 days per
4 benefit year, the durational limits, dollar amounts, and
5 coinsurance factors thereto need not be the same as applicable
6 to physical illness generally.
7 (b) Outpatient benefits may be limited to $1,000 for
8 consultations with a licensed physician, a psychologist
9 licensed pursuant to chapter 490, a mental health counselor
10 licensed pursuant to chapter 491, a marriage and family
11 therapist licensed pursuant to chapter 491, and a clinical
12 social worker licensed pursuant to chapter 491. If benefits
13 are provided beyond the $1,000 per benefit year, the
14 durational limits, dollar amounts, and coinsurance factors
15 thereof need not be the same as applicable to physical illness
16 generally.
17 (c) Partial hospitalization benefits shall be provided
18 under the direction of a licensed physician. For purposes of
19 this part, the term "partial hospitalization services" is
20 defined as those services offered by a program accredited by
21 the Joint Commission on Accreditation of Hospitals (JCAH) or
22 in compliance with equivalent standards. Alcohol
23 rehabilitation programs accredited by the Joint Commission on
24 Accreditation of Hospitals or approved by the state and
25 licensed drug abuse rehabilitation programs shall also be
26 qualified providers under this section. In any benefit year,
27 if partial hospitalization services or a combination of
28 inpatient and partial hospitalization are utilized, the total
29 benefits paid for all such services shall not exceed the cost
30 of 30 days of inpatient hospitalization for psychiatric
31 services, including physician fees, which prevail in the
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CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2007 SB 1834
13-634A-07 See HB 291
1 community in which the partial hospitalization services are
2 rendered. If partial hospitalization services benefits are
3 provided beyond the limits set forth in this paragraph, the
4 durational limits, dollar amounts, and coinsurance factors
5 thereof need not be the same as those applicable to physical
6 illness generally.
7 (3) In the case of a group health plan that offers a
8 participant or beneficiary two or more benefit package options
9 under the plan, the requirements of this section shall be
10 applied separately with respect to each such option.
11 (4)(3) Insurers must maintain strict confidentiality
12 regarding psychiatric and psychotherapeutic records submitted
13 to an insurer for the purpose of reviewing a claim for
14 benefits payable under this section. These records submitted
15 to an insurer are subject to the limitations of s. 456.057,
16 relating to the furnishing of patient records.
17 Section 2. This act shall take effect July 1, 2007.
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