HB 19

1	A bill to be entitled
2	An act relating to coverage for mental, nervous, and
3	substance-related disorders; amending s. 627.668, F.S.;
4	revising requirements for optional coverage for mental,
5	nervous, and substance-related disorders; revising certain
6	benefits limitations; providing an options application
7	requirement; repealing s. 627.669, F.S., relating to
8	optional coverage required for substance abuse impaired
9	persons; amending s. 627.6675, F.S.; conforming a cross-
10	reference; providing an effective date.
11
12	Be It Enacted by the Legislature of the State of Florida:
13
14	Section 1.  Section 627.668, Florida Statutes, is amended
15	to read:
16	627.668  Optional coverage for mental, and nervous, and
17	substance-related disorders required; exception.--
18	(1)  Every insurer, health maintenance organization, and
19	nonprofit hospital and medical service plan corporation
20	transacting group health insurance or providing prepaid health
21	care in this state shall make available to the policyholder as
22	part of the application, for an appropriate additional premium
23	under a group hospital and medical expense-incurred insurance
24	policy, under a group prepaid health care contract, and under a
25	group hospital and medical service plan contract, the benefits
26	or level of benefits specified in subsection (2) for all
27	diagnostic categories of mental health and substance-related
28	disorders listed in the most recent edition of the Diagnostic
29	and Statistical Manual of Mental Disorders, published by the
30	American Psychiatric Association, and as listed in the mental
31	and behavioral disorders section of the current International
32	Classification of Diseases, to include schizophrenia,
33	schizophreniform disorders, schizo-affective disorders, paranoid
34	and other psychotic disorders, bipolar disorders, panic
35	disorders, obsessive-compulsive disorders, major depressive
36	disorders, anxiety disorders, mood disorders, pervasive
37	development disorders or autism, depression in childhood and
38	adolescence, personality disorders, paraphilias, attention
39	deficit and disruptive behavior disorders, tic disorders, eating
40	disorders including bulimia and anorexia, substance-related
41	disorders, Asperger's disorder, intermittent explosive disorder,
42	posttraumatic stress disorder, psychosis not otherwise specified
43	(NOS) when diagnosed in a child under 17 years of age, Rett's
44	disorder, Tourette's disorder, delirium, and dementia the
45	necessary care and treatment of mental and nervous disorders, as
46	defined in the standard nomenclature of the American Psychiatric
47	Association, subject to the right of the applicant for a group
48	policy or contract to select any alternative benefits or level
49	of benefits as may be offered by the insurer, health maintenance
50	organization, or service plan corporation provided that, if
51	alternate inpatient, outpatient, or partial hospitalization
52	benefits are selected, such benefits shall not be less than the
53	level of benefits required under subsection paragraph (2)(a),
54	paragraph (2)(b), or paragraph (2)(c), respectively.
55	(2)  Under group policies or contracts, inpatient hospital
56	benefits, partial hospitalization benefits, and outpatient
57	benefits consisting of durational limits, dollar amounts,
58	deductibles, and coinsurance factors may not be more restrictive
59	than the treatment limitations and cost-sharing requirements
60	under the plan that are applicable to other disease, illnesses,
61	and medical conditions. shall not be less favorable than for
62	physical illness generally, except that:
63	(a)  Inpatient benefits may be limited to not less than 30
64	days per benefit year as defined in the policy or contract. If
65	inpatient hospital benefits are provided beyond 30 days per
66	benefit year, the durational limits, dollar amounts, and
67	coinsurance factors thereto need not be the same as applicable
68	to physical illness generally.
69	(b)  Outpatient benefits may be limited to $1,000 for
70	consultations with a licensed physician, a psychologist licensed
71	pursuant to chapter 490, a mental health counselor licensed
72	pursuant to chapter 491, a marriage and family therapist
73	licensed pursuant to chapter 491, and a clinical social worker
74	licensed pursuant to chapter 491. If benefits are provided
75	beyond the $1,000 per benefit year, the durational limits,
76	dollar amounts, and coinsurance factors thereof need not be the
77	same as applicable to physical illness generally.
78	(c)  Partial hospitalization benefits shall be provided
79	under the direction of a licensed physician. For purposes of
80	this part, the term "partial hospitalization services" is
81	defined as those services offered by a program accredited by the
82	Joint Commission on Accreditation of Hospitals (JCAH) or in
83	compliance with equivalent standards. Alcohol rehabilitation
84	programs accredited by the Joint Commission on Accreditation of
85	Hospitals or approved by the state and licensed drug abuse
86	rehabilitation programs shall also be qualified providers under
87	this section. In any benefit year, if partial hospitalization
88	services or a combination of inpatient and partial
89	hospitalization are utilized, the total benefits paid for all
90	such services shall not exceed the cost of 30 days of inpatient
91	hospitalization for psychiatric services, including physician
92	fees, which prevail in the community in which the partial
93	hospitalization services are rendered. If partial
94	hospitalization services benefits are provided beyond the limits
95	set forth in this paragraph, the durational limits, dollar
96	amounts, and coinsurance factors thereof need not be the same as
97	those applicable to physical illness generally.
98	(3)  In the case of a group health plan that offers a
99	participant or beneficiary two or more benefit package options
100	under the plan, the requirements of this section shall be
101	applied separately with respect to each such option.
102	(4)(3)  Insurers must maintain strict confidentiality
103	regarding psychiatric and psychotherapeutic records submitted to
104	an insurer for the purpose of reviewing a claim for benefits
105	payable under this section. These records submitted to an
106	insurer are subject to the limitations of s. 456.057, relating
107	to the furnishing of patient records.
108	Section 2.  Section 627.669, Florida Statutes, is repealed.
109	Section 3.  Paragraph (b) of subsection (8) of section
110	627.6675, Florida Statutes, is amended to read:
111	627.6675  Conversion on termination of
112	eligibility.--Subject to all of the provisions of this section,
113	a group policy delivered or issued for delivery in this state by
114	an insurer or nonprofit health care services plan that provides,
115	on an expense-incurred basis, hospital, surgical, or major
116	medical expense insurance, or any combination of these
117	coverages, shall provide that an employee or member whose
118	insurance under the group policy has been terminated for any
119	reason, including discontinuance of the group policy in its
120	entirety or with respect to an insured class, and who has been
121	continuously insured under the group policy, and under any group
122	policy providing similar benefits that the terminated group
123	policy replaced, for at least 3 months immediately prior to
124	termination, shall be entitled to have issued to him or her by
125	the insurer a policy or certificate of health insurance,
126	referred to in this section as a "converted policy." A group
127	insurer may meet the requirements of this section by contracting
128	with another insurer, authorized in this state, to issue an
129	individual converted policy, which policy has been approved by
130	the office under s. 627.410. An employee or member shall not be
131	entitled to a converted policy if termination of his or her
132	insurance under the group policy occurred because he or she
133	failed to pay any required contribution, or because any
134	discontinued group coverage was replaced by similar group
135	coverage within 31 days after discontinuance.
136	(8)  BENEFITS OFFERED.--
137	(b)  An insurer shall offer the benefits specified in s.
138	627.668 and the benefits specified in s. 627.669 if those
139	benefits were provided in the group plan.
140	Section 4.  This act shall take effect January 1, 2009.

CODING: Words stricken are deletions; words underlined are additions.