CS/CS/HB 19

1	A bill to be entitled
2	An act relating to optional coverage for mental and
3	nervous disorders; amending s. 627.668, F.S.; revising
4	requirements for optional coverage for mental and nervous
5	disorders; revising certain benefits limitations; limiting
6	applicability; providing definitions; permitting benefits
7	to be provided by an exclusive provider or group of
8	exclusive providers; permitting benefits to be provided
9	through a contract with exclusive providers; providing for
10	care management; providing an exemption; providing an
11	effective date.
12
13	Be It Enacted by the Legislature of the State of Florida:
14
15	Section 1.  Present subsection (3) of section 627.668,
16	Florida Statutes, is renumbered as subsection (4), and a new
17	subsection (3) is added to that section to read:
18	627.668  Optional coverage for mental and nervous disorders
19	required; exception.--
20	(3)(a)  Every insurer and health maintenance organization
21	transacting group health insurance or providing prepaid health
22	care in this state shall make available to the policyholder, for
23	an appropriate additional premium, as part of the application
24	for a group hospital and medical expense-incurred insurance
25	policy under a group prepaid health care contract or a group
26	health maintenance organization contract, coverage for the
27	treatment of serious mental illness, which treatment is
28	determined to be medically necessary. With respect to the state
29	group insurance program, the term "policyholder" means the State
30	of Florida.
31	(b)  Under group policies or contracts, inpatient hospital
32	benefits, partial hospitalization benefits, and outpatient
33	benefits consisting of durational limits, dollar amounts,
34	deductibles, and coinsurance factors must be the same for
35	serious mental illness as for physical illness generally.
36	Notwithstanding the provisions of this subsection, an insurer or
37	health maintenance organization may limit inpatient coverage to
38	45 days per year and may limit outpatient coverage to 60 visits
39	per year.
40	(c)  This subsection does not apply to any group health
41	plan or group health insurance covered in connection with a
42	group health plan for any plan year of a small employer as
43	defined in s. 627.6699.
44	(d)  As used in this subsection, the term "serious mental
45	illness" means the following psychiatric illnesses as defined by
46	the American Psychiatric Association in the most current edition
47	of the Diagnostic and Statistical Manual of Mental Disorders:
48	schizophrenia, schizoaffective disorder, panic disorder, bipolar
49	affective disorder, major depressive disorder, and obsessive-
50	compulsive disorder.
51	(e)  Notwithstanding other provisions of this section,
52	chapter 641, s. 627.6471, or s. 627.6472, an insurer or health
53	maintenance organization may require that the covered services
54	required by this subsection be provided by an exclusive provider
55	of health care or a group of exclusive providers of health care
56	which has entered into a written agreement with the insurer or
57	health maintenance organization to provide benefits under this
58	subsection. The insurer or health maintenance organization may
59	condition the payment of such benefits, in whole or in part, on
60	the use of such exclusive providers.
61	(f)  The insurer or health maintenance organization may
62	directly or indirectly enter into a contract with an exclusive
63	provider of health care or a group of exclusive providers of
64	health care to provide benefits under this subsection. In
65	providing benefits under this subsection, the insurer or health
66	maintenance organization may impose other appropriate financial
67	incentives, peer review, utilization requirements, and other
68	methods used for the management of benefits provided for other
69	medical conditions or by management methods unique to mental
70	health benefits to reduce service costs and utilization without
71	compromising quality of care.
72	(g)  This subsection does not apply with respect to a group
73	health plan or health insurance coverage offered in connection
74	with a group health plan if the application of this subsection
75	to such plan or coverage results in an increase in the cost
76	under the plan or for such coverage of at least 2 percent, as
77	determined and certified by an insurer's or health maintenance
78	organization's actuary.
79	Section 2.  This act shall take effect July 1, 2008.

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