HB 291

1	A bill to be entitled
2	An act relating to coverage for mental and nervous
3	disorders; amending s. 627.668, F.S.; revising
4	requirements for optional coverage for mental and nervous
5	disorders; revising certain benefits limitations;
6	providing an options application requirement; providing an
7	effective date.
8
9	Be It Enacted by the Legislature of the State of Florida:
10
11	Section 1.  Section 627.668, Florida Statutes, is amended
12	to read:
13	627.668  Optional coverage for mental and nervous disorders
14	required; exception.--
15	(1)  Every insurer, health maintenance organization, and
16	nonprofit hospital and medical service plan corporation
17	transacting group health insurance or providing prepaid health
18	care in this state shall make available to the policyholder as
19	part of the application, for an appropriate additional premium
20	under a group hospital and medical expense-incurred insurance
21	policy, under a group prepaid health care contract, and under a
22	group hospital and medical service plan contract, the benefits
23	or level of benefits specified in subsection (2) for all
24	diagnostic categories of mental health conditions listed in the
25	most recent edition of the Diagnostic and Statistical Manual of
26	Mental Disorders, published by the American Psychiatric
27	Association, and as listed in the mental and behavioral
28	disorders section of the current International Classification of
29	Diseases, to include schizophrenia, schizophrenia-form
30	disorders, schizo-affective disorders, paranoid and other
31	psychotic disorders, bipolar disorders, panic disorders,
32	obsessive-compulsive disorders, major depressive disorders,
33	anxiety disorders, mood disorders, pervasive development
34	disorders or autism, depression in childhood and adolescence,
35	personality disorders, paraphilias, attention deficit and
36	disruptive behavior disorders, tic disorders, eating disorders
37	including bulimia and anorexia, Asperger's disorder,
38	intermittent explosive disorder, posttraumatic stress disorder,
39	psychosis not otherwise specified (NOS) when diagnosed in a
40	child under 17 years of age, Rett's disorder, Tourette's
41	disorder, delirium, and dementia the necessary care and
42	treatment of mental and nervous disorders, as defined in the
43	standard nomenclature of the American Psychiatric Association,
44	subject to the right of the applicant for a group policy or
45	contract to select any alternative benefits or level of benefits
46	as may be offered by the insurer, health maintenance
47	organization, or service plan corporation provided that, if
48	alternate inpatient, outpatient, or partial hospitalization
49	benefits are selected, such benefits shall not be less than the
50	level of benefits required under subsection paragraph (2)(a),
51	paragraph (2)(b), or paragraph (2)(c), respectively.
52	(2)  Under group policies or contracts, inpatient hospital
53	benefits, partial hospitalization benefits, and outpatient
54	benefits consisting of durational limits, dollar amounts,
55	deductibles, and coinsurance factors may not be more restrictive
56	than the treatment limitations and cost-sharing requirements
57	under the plan that are applicable to other disease, illnesses,
58	and medical conditions. shall not be less favorable than for
59	physical illness generally, except that:
60	(a)  Inpatient benefits may be limited to not less than 30
61	days per benefit year as defined in the policy or contract. If
62	inpatient hospital benefits are provided beyond 30 days per
63	benefit year, the durational limits, dollar amounts, and
64	coinsurance factors thereto need not be the same as applicable
65	to physical illness generally.
66	(b)  Outpatient benefits may be limited to $1,000 for
67	consultations with a licensed physician, a psychologist licensed
68	pursuant to chapter 490, a mental health counselor licensed
69	pursuant to chapter 491, a marriage and family therapist
70	licensed pursuant to chapter 491, and a clinical social worker
71	licensed pursuant to chapter 491. If benefits are provided
72	beyond the $1,000 per benefit year, the durational limits,
73	dollar amounts, and coinsurance factors thereof need not be the
74	same as applicable to physical 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 accredited by the
79	Joint Commission on Accreditation of Hospitals (JCAH) or in
80	compliance with equivalent standards. Alcohol rehabilitation
81	programs accredited by the Joint Commission on Accreditation of
82	Hospitals or approved by the state and licensed drug abuse
83	rehabilitation programs shall also be qualified providers under
84	this section. In any benefit year, if partial hospitalization
85	services or a combination of inpatient and partial
86	hospitalization are utilized, the total benefits paid for all
87	such services shall not exceed the cost of 30 days of inpatient
88	hospitalization for psychiatric services, including physician
89	fees, which prevail in the community in which the partial
90	hospitalization services are rendered. If partial
91	hospitalization services benefits are provided beyond the limits
92	set forth in this paragraph, the durational limits, dollar
93	amounts, and coinsurance factors thereof need not be the same as
94	those applicable to physical illness generally.
95	(3)  In the case of a group health plan that offers a
96	participant or beneficiary two or more benefit package options
97	under the plan, the requirements of this section shall be
98	applied separately with respect to each such option.
99	(4)(3)  Insurers must maintain strict confidentiality
100	regarding psychiatric and psychotherapeutic records submitted to
101	an insurer for the purpose of reviewing a claim for benefits
102	payable under this section. These records submitted to an
103	insurer are subject to the limitations of s. 456.057, relating
104	to the furnishing of patient records.
105	Section 2.  This act shall take effect July 1, 2007.

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