Florida Senate - 2018                                     SB 154
       
       
        
       By Senator Stewart
       
       
       
       
       
       13-00070-18                                            2018154__
    1                        A bill to be entitled                      
    2         An act relating to insurance coverage for mental and
    3         nervous disorders; amending s. 627.668, F.S.;
    4         requiring specified entities that transact group
    5         health insurance or provide prepaid health care to
    6         make available to policyholders under specified
    7         policies and contracts certain benefits for the care
    8         and treatment of mental and nervous disorders without
    9         an additional premium; providing that alternative
   10         residential treatment benefits offered by certain
   11         entities may not be less than a specified level of
   12         benefits; defining the term “residential treatment”;
   13         revising coverage limit requirements on inpatient
   14         hospital benefits, outpatient benefits, and partial
   15         hospitalization benefits; requiring policies and
   16         contracts to provide for the transfer of unused
   17         inpatient hospital benefits to outpatient benefits or
   18         residential treatment benefits; providing an effective
   19         date.
   20          
   21  Be It Enacted by the Legislature of the State of Florida:
   22  
   23         Section 1. Section 627.668, Florida Statutes, is amended to
   24  read:
   25         627.668 Optional Coverage for mental and nervous disorders
   26  required; exception.—
   27         (1) Every insurer, health maintenance organization, and
   28  nonprofit hospital and medical service plan corporation
   29  transacting group health insurance or providing prepaid health
   30  care in this state shall make available to the policyholder as
   31  part of the application, for an appropriate additional premium
   32  under a group hospital and medical expense-incurred insurance
   33  policy, under a group prepaid health care contract, and under a
   34  group hospital and medical service plan contract, the benefits
   35  or level of benefits specified in subsection (2) for the
   36  necessary care and treatment of mental and nervous disorders, as
   37  defined in the standard nomenclature of the American Psychiatric
   38  Association, subject to the right of the applicant for a group
   39  policy or contract to select any alternative benefits or level
   40  of benefits as may be offered by the insurer, health maintenance
   41  organization, or service plan corporation. provided that, If
   42  alternative alternate inpatient, outpatient, or partial
   43  hospitalization, or residential treatment benefits are selected,
   44  such benefits may shall not be less than the level of benefits
   45  required under subsection (2) paragraph (2)(a), paragraph
   46  (2)(b), or paragraph (2)(c), respectively. For purposes of this
   47  section, the term “residential treatment” means placement for
   48  observation, diagnosis, or treatment of mental or nervous
   49  disorders in a residential treatment facility licensed under s.
   50  394.875 or a hospital licensed under chapter 395.
   51         (2) Under group policies or contracts, inpatient hospital
   52  benefits, partial hospitalization benefits, and outpatient
   53  benefits consisting of durational limits, dollar amounts,
   54  deductibles, and coinsurance factors may shall not be less
   55  favorable than for physical illness generally, except that:
   56         (a) Inpatient benefits may be limited to not less than 45
   57  30 days per benefit year as defined in the policy or contract.
   58  If inpatient hospital benefits are provided beyond 45 30 days
   59  per benefit year, the durational limits, dollar amounts, and
   60  coinsurance factors thereto need not be the same as applicable
   61  to physical illness generally. However, the policy or contract
   62  must provide that unused inpatient hospital benefits may be
   63  transferred to either outpatient benefits or residential
   64  treatment benefits.
   65         (b) Outpatient benefits may be limited to 30 hours of
   66  $1,000 for consultations with a licensed physician, a
   67  psychologist licensed pursuant to chapter 490, a mental health
   68  counselor licensed pursuant to chapter 491, a marriage and
   69  family therapist licensed pursuant to chapter 491, and a
   70  clinical social worker licensed pursuant to chapter 491. If
   71  benefits are provided beyond 30 hours the $1,000 per benefit
   72  year, the durational limits, dollar amounts, and coinsurance
   73  factors thereof need not be the same as applicable to physical
   74  illness generally.
   75         (c) Partial hospitalization benefits shall be provided
   76  under the direction of a licensed physician. For purposes of
   77  this part, the term “partial hospitalization services” is
   78  defined as those services offered by a program that is
   79  accredited by an accrediting organization whose standards
   80  incorporate comparable regulations required by this state.
   81  Alcohol rehabilitation programs accredited by an accrediting
   82  organization whose standards incorporate comparable regulations
   83  required by this state or approved by the state and licensed
   84  drug abuse rehabilitation programs shall also be qualified
   85  providers under this section. In a given benefit year, if
   86  partial hospitalization services or a combination of inpatient
   87  and partial hospitalization are used, the total benefits paid
   88  for all such services may not exceed the cost of 121 30 days
   89  after inpatient hospitalization for psychiatric services,
   90  including physician fees, which prevail in the community in
   91  which the partial hospitalization services are rendered. If
   92  partial hospitalization services benefits are provided beyond
   93  the limits set forth in this paragraph, the durational limits,
   94  dollar amounts, and coinsurance factors thereof need not be the
   95  same as those applicable to physical illness generally.
   96         (3) Insurers must maintain strict confidentiality regarding
   97  psychiatric and psychotherapeutic records submitted to an
   98  insurer for the purpose of reviewing a claim for benefits
   99  payable under this section. These records submitted to an
  100  insurer are subject to the limitations of s. 456.057, relating
  101  to the furnishing of patient records.
  102         Section 2. This act shall take effect July 1, 2018.