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House Bill 0041

Florida House of Representatives - 1997 HB 41 By Representative Brennan 1 A bill to be entitled 2 An act relating to health insurance; providing 3 a short title; providing application; amending 4 s. 627.668, F.S.; providing that the current 5 requirement for group insurers to offer 6 coverage for mental health conditions does not 7 apply to serious mental illness; creating s. 8 627.6681, F.S.; requiring group health insurers 9 and health maintenance organizations to provide 10 coverage for serious mental illness; requiring 11 benefits 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; providing definitions; 16 providing an appropriation; providing a 17 description of state interest; providing an 18 effective date. 19 20 Be It Enacted by the Legislature of the State of Florida: 21 22 Section 1. This act may be cited as the "Mental 23 Illness Insurance Parity Act." 24 Section 2. Section 627.668, Florida Statutes, is 25 amended to read: 26 627.668 Optional coverage for mental and nervous 27 disorders required; exception.-- 28 (1) Every insurer, health maintenance organization, 29 and nonprofit hospital and medical service plan corporation 30 transacting group health insurance or providing prepaid health 31 care in this state shall make available to the policyholder as 1 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 41 220-136E-97 1 part of the application, for an appropriate additional premium 2 under a group hospital and medical expense-incurred insurance 3 policy, under a group prepaid health care contract, and under 4 a group hospital and medical service plan contract, the 5 benefits or level of benefits specified in subsection (2) for 6 the necessary care and treatment of mental and nervous 7 disorders, as defined in the standard nomenclature of the 8 American Psychiatric Association, except this section shall 9 not apply to coverage for serious mental illness as defined in 10 s. 627.6681. The coverage required in this section shall be 11 subject to the right of the applicant for a group policy or 12 contract to select any alternative benefits or level of 13 benefits as may be offered by the insurer, health maintenance 14 organization, or service plan corporation provided that, if 15 alternate inpatient, outpatient, or partial hospitalization 16 benefits are selected, such benefits shall not be less than 17 the level of benefits required under paragraph (2)(a), 18 paragraph (2)(b), or paragraph (2)(c), respectively. 19 (2) Under group policies or contracts, inpatient 20 hospital benefits, partial hospitalization benefits, and 21 outpatient benefits provided pursuant to this section, 22 consisting of durational limits, dollar amounts, deductibles, 23 and coinsurance factors shall not be less favorable than for 24 physical illness generally, except that: 25 (a) Inpatient benefits may be limited to not less than 26 30 days per benefit year as defined in the policy or contract. 27 If inpatient hospital benefits are provided beyond 30 days per 28 benefit year, the durational limits, dollar amounts, and 29 coinsurance factors thereto need not be the same as applicable 30 to physical illness generally. 31 2 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 41 220-136E-97 1 (b) Outpatient benefits may be limited to $1,000 for 2 consultations with a licensed physician, a psychologist 3 licensed pursuant to chapter 490, a mental health counselor 4 licensed pursuant to chapter 491, a marriage and family 5 therapist licensed pursuant to chapter 491, and a clinical 6 social worker licensed pursuant to chapter 491. If benefits 7 are provided beyond the $1,000 per benefit year, the 8 durational limits, dollar amounts, and coinsurance factors 9 thereof need not be the same as applicable to physical illness 10 generally. 11 (c) Partial hospitalization benefits shall be provided 12 under the direction of a licensed physician. For purposes of 13 this part, the term "partial hospitalization services" is 14 defined as those services offered by a program accredited by 15 the Joint Commission on Accreditation of Hospitals (JCAH) or 16 in compliance with equivalent standards. Alcohol 17 rehabilitation programs accredited by the Joint Commission on 18 Accreditation of Hospitals or approved by the state and 19 licensed drug abuse rehabilitation programs shall also be 20 qualified providers under this section. In any benefit year, 21 if partial hospitalization services or a combination of 22 inpatient and partial hospitalization are utilized, the total 23 benefits paid for all such services shall not exceed the cost 24 of 30 days of inpatient hospitalization for psychiatric 25 services, including physician fees, which prevail in the 26 community in which the partial hospitalization services are 27 rendered. If partial hospitalization services benefits are 28 provided beyond the limits set forth in this paragraph, the 29 durational limits, dollar amounts, and coinsurance factors 30 thereof need not be the same as those applicable to physical 31 illness generally. 3 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 41 220-136E-97 1 (3) Insurers providing coverage pursuant to this 2 section and s. 627.6681 must maintain strict confidentiality 3 regarding psychiatric and psychotherapeutic records submitted 4 to an insurer for the purpose of reviewing a claim for 5 benefits payable under this section. These records submitted 6 to an insurer are subject to the limitations of s. 455.241, 7 relating to the furnishing of patient records. 8 Section 3. Section 627.6681, Florida Statutes, is 9 created to read: 10 627.6681 Coverage for serious mental illness 11 required.-- 12 (1) Every insurer and health maintenance organization 13 transacting group health insurance or providing prepaid health 14 care in this state shall provide as part of such insurance or 15 health care under a group hospital and medical 16 expense-incurred insurance policy, or under a group prepaid 17 health care contract, coverage for the treatment of serious 18 mental illness, which treatment is determined to be medically 19 necessary. When a diagnosis of serious mental illness is 20 accompanied by substance abuse, treatment for the patient who 21 is dually diagnosed shall include, but not be limited to, 22 treatment for substance abuse. 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 shall be the 27 same for serious mental illness as for physical illness 28 generally. 29 (3) The standard, basic, and limited health benefit 30 plan committee, duly appointed in the manner provided in s. 31 627.6699(12)(a)1., shall consider the modification of the 4 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 41 220-136E-97 1 standard, basic, and limited health benefit plans developed 2 pursuant to s. 627.6699(12), to include coverage for serious 3 mental illness as prescribed in this section. The committee 4 shall submit any recommended modifications to the department 5 for approval. 6 (4) As used in this section, the term "serious mental 7 illness" means any mental illness that is recognized in the 8 latest edition of relevant manuals of the American Psychiatric 9 Association or by the International Classification of 10 Diseases, and affirmed by medical science as caused by 11 biological disorder of the brain, and that substantially 12 limits the life activities of the patient. The term includes, 13 but is not limited to, schizophrenia, schizoaffective 14 disorders, anxiety and panic disorders, bipolar affective 15 disorders, major depression, and obsessive compulsive 16 disorder. 17 Section 4. There is hereby appropriated to the 18 Department of Insurance from the Insurance Commissioner's 19 Regulatory Trust Fund for fiscal year 1997-1998 one full-time 20 equivalent position and $38,288 to implement the provisions of 21 this act. 22 Section 5. The provisions of this bill fulfill an 23 important state interest in that they promote the relief and 24 alleviation of health or medical problems that affect 25 significant portions of the state's population. The bill, in 26 requiring insurance coverage, should facilitate closer 27 scrutiny of the treatment of these conditions, resulting in 28 more cost-efficient and effective treatment of such 29 conditions. By improving the overall level and quality of 30 health care, the bill will have the effect of reducing total 31 costs of medical plans under which treatment is provided for 5 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 41 220-136E-97 1 these conditions, thereby reducing public medical assistance 2 benefits as well as outlays for persons covered under all 3 medical plans. 4 Section 6. This act shall take effect October 1, 1997, 5 and shall apply to any policy issued, written, or renewed in 6 this state on or after such date. 7 8 ***************************************** 9 HOUSE SUMMARY 10 Creates the "Mental Illness Insurance Parity Act." Provides that the current requirement for group insurers 11 to offer coverage for mental health conditions does not apply to serious mental illness. Requires group health 12 insurers and health maintenance organizations to provide coverage for serious mental illness and requires benefits 13 to be the same as for physical illness generally. See bill for details. 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 6