CS/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
7	for contingent application to certain persons; providing
8	an effective date.
9
10	Be It Enacted by the Legislature of the State of Florida:
11
12	Section 1.  Section 627.668, Florida Statutes, is amended
13	to read:
14	627.668  Optional coverage for mental and nervous disorders
15	required; exception.--
16	(1)  Every insurer, health maintenance organization, and
17	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 a
23	group hospital and medical service plan contract, the benefits
24	or level of benefits specified in subsection (2) for all
25	diagnostic categories of mental health conditions listed in the
26	most recent edition of the Diagnostic and Statistical Manual of
27	Mental Disorders, published by the American Psychiatric
28	Association, and as listed in the mental and behavioral
29	disorders section of the current International Classification of
30	Diseases, to include schizophrenia, schizophrenia-form
31	disorders, schizo-affective disorders, paranoid and other
32	psychotic disorders, bipolar disorders, panic disorders,
33	obsessive-compulsive disorders, major depressive disorders,
34	anxiety disorders, mood disorders, pervasive development
35	disorders or autism, depression in childhood and adolescence,
36	personality disorders, paraphilias, attention deficit and
37	disruptive behavior disorders, tic disorders, eating disorders
38	including bulimia and anorexia, Asperger's disorder,
39	intermittent explosive disorder, posttraumatic stress disorder,
40	psychosis not otherwise specified (NOS) when diagnosed in a
41	child under 17 years of age, Rett's disorder, Tourette's
42	disorder, delirium, and dementia the necessary care and
43	treatment of mental and nervous disorders, as defined in the
44	standard nomenclature of the American Psychiatric Association,
45	subject to the right of the applicant for a group policy or
46	contract to select any alternative benefits or level of benefits
47	as may be offered by the insurer, health maintenance
48	organization, or service plan corporation provided that, if
49	alternate inpatient, outpatient, or partial hospitalization
50	benefits are selected, such benefits shall not be less than the
51	level of benefits required under subsection paragraph (2)(a),
52	paragraph (2)(b), or paragraph (2)(c), respectively.
53	(2)  Under group policies or contracts, inpatient hospital
54	benefits, partial hospitalization benefits, and outpatient
55	benefits consisting of durational limits, dollar amounts,
56	deductibles, and coinsurance factors may not be more restrictive
57	than the treatment limitations and cost-sharing requirements
58	under the plan that are applicable to other disease, illnesses,
59	and medical conditions. shall not be less favorable than for
60	physical illness generally, except that:
61	(a)  Inpatient benefits may be limited to not less than 30
62	days per benefit year as defined in the policy or contract. If
63	inpatient hospital benefits are provided beyond 30 days per
64	benefit year, the durational limits, dollar amounts, and
65	coinsurance factors thereto need not be the same as applicable
66	to physical illness generally.
67	(b)  Outpatient benefits may be limited to $1,000 for
68	consultations with a licensed physician, a psychologist licensed
69	pursuant to chapter 490, a mental health counselor licensed
70	pursuant to chapter 491, a marriage and family therapist
71	licensed pursuant to chapter 491, and a clinical social worker
72	licensed pursuant to chapter 491. If benefits are provided
73	beyond the $1,000 per benefit year, the durational limits,
74	dollar amounts, and coinsurance factors thereof need not be the
75	same as applicable to physical illness generally.
76	(c)  Partial hospitalization benefits shall be provided
77	under the direction of a licensed physician. For purposes of
78	this part, the term "partial hospitalization services" is
79	defined as those services offered by a program accredited by the
80	Joint Commission on Accreditation of Hospitals (JCAH) or in
81	compliance with equivalent standards. Alcohol rehabilitation
82	programs accredited by the Joint Commission on Accreditation of
83	Hospitals or approved by the state and licensed drug abuse
84	rehabilitation programs shall also be qualified providers under
85	this section. In any benefit year, if partial hospitalization
86	services or a combination of inpatient and partial
87	hospitalization are utilized, the total benefits paid for all
88	such services shall not exceed the cost of 30 days of inpatient
89	hospitalization for psychiatric services, including physician
90	fees, which prevail in the community in which the partial
91	hospitalization services are rendered. If partial
92	hospitalization services benefits are provided beyond the limits
93	set forth in this paragraph, the durational limits, dollar
94	amounts, and coinsurance factors thereof need not be the same as
95	those applicable to physical illness generally.
96	(3)  In the case of a group health plan that offers a
97	participant or beneficiary two or more benefit package options
98	under the plan, the requirements of this section shall be
99	applied separately with respect to each such option.
100	(4)(3)  Insurers must maintain strict confidentiality
101	regarding psychiatric and psychotherapeutic records submitted to
102	an insurer for the purpose of reviewing a claim for benefits
103	payable under this section. These records submitted to an
104	insurer are subject to the limitations of s. 456.057, relating
105	to the furnishing of patient records.
106	Section 2.  This act shall take effect October 1, 2007,
107	except that the amendments to s. 627.668, Florida Statutes, made
108	by this act and incorporated under the State Group Insurance
109	Program established pursuant to s. 110.123, Florida Statutes,
110	shall not apply to state employees unless a specific
111	appropriation for that purpose is made in the General
112	Appropriations Act for fiscal year 2007-2008.

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