HB 147

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 and limitations for optional coverage for
5	mental and nervous disorders; specifying nonapplication
6	under certain circumstances; amending s. 627.6675, F.S.;
7	conforming a cross-reference; repealing s. 627.669, F.S.,
8	relating to optional coverage required for substance abuse
9	impaired persons; providing an effective date.
10
11	Be It Enacted by the Legislature of the State of Florida:
12
13	Section 1.  Section 627.668, Florida Statutes, is amended
14	to read:
15	627.668  Optional coverage for mental and nervous disorders
16	required; exception.--
17	(1)  Every insurer, health maintenance organization, and
18	nonprofit hospital and medical service plan corporation
19	transacting group health insurance or providing prepaid health
20	care in this state shall make available to the policyholder as
21	part of the application, for an appropriate additional premium
22	under a group hospital and medical expense-incurred insurance
23	policy, under a group prepaid health care contract, and under a
24	group hospital and medical service plan contract, the benefits
25	or level of benefits specified in subsections subsection (2) and
26	(3) for the necessary care and treatment of mental and nervous
27	disorders, as defined in the most recent edition of the
28	Diagnostic and Statistical Manual of Mental Disorders published
29	by standard nomenclature of the American Psychiatric
30	Association, subject to the right of the applicant for a group
31	policy or contract to select any alternative benefits or level
32	of benefits as may be offered by the insurer, health maintenance
33	organization, or service plan corporation, provided that, if
34	alternate inpatient, outpatient, or partial hospitalization
35	benefits are selected, such benefits shall not be less than the
36	level of benefits required under subsections (2) and (3)
37	paragraph (2)(a), paragraph (2)(b), or paragraph (2)(c),
38	respectively. With respect to the state group insurance program,
39	the term "policyholder" means the State of Florida.
40	(2)  Under group policies or contracts, inpatient hospital
41	benefits, partial hospitalization benefits, and outpatient
42	benefits consisting of durational limits, dollar amounts,
43	deductibles, and coinsurance factors shall not be less favorable
44	than for physical illness generally for the necessary care and
45	treatment of schizophrenia and psychotic disorders, mood
46	disorders, anxiety disorders, substance abuse disorders, eating
47	disorders, and childhood ADD/ADHD.
48	(3)(2)  Under group policies or contracts, inpatient
49	hospital benefits, partial hospitalization benefits, and
50	outpatient benefits for mental health disorders not listed in
51	subsection (2) consisting of durational limits, dollar amounts,
52	deductibles, and coinsurance factors shall not be less favorable
53	than for physical illness generally, except that:
54	(a)  Inpatient benefits may be limited to not less than 45
55	30 days per benefit year as defined in the policy or contract.
56	If inpatient hospital benefits are provided beyond 45 30 days
57	per benefit year, the durational limits, dollar amounts, and
58	coinsurance factors thereto need not be the same as applicable
59	to physical illness generally.
60	(b)  Outpatient benefits may be limited to 60 visits per
61	benefit year $1,000 for consultations with a licensed physician,
62	a psychologist licensed pursuant to chapter 490, a mental health
63	counselor licensed pursuant to chapter 491, a marriage and
64	family therapist licensed pursuant to chapter 491, and a
65	clinical social worker licensed pursuant to chapter 491. If
66	benefits are provided beyond the 60 visits $1,000 per benefit
67	year, the durational limits, dollar amounts, and coinsurance
68	factors thereof need not be the same as applicable to physical
69	illness generally.
70	(c)  Partial hospitalization benefits shall be provided
71	under the direction of a licensed physician. For purposes of
72	this part, the term "partial hospitalization services" is
73	defined as those services offered by a program accredited by the
74	Joint Commission on Accreditation of Hospitals (JCAH) or in
75	compliance with equivalent standards. Alcohol rehabilitation
76	programs accredited by the Joint Commission on Accreditation of
77	Hospitals or approved by the state and licensed drug abuse
78	rehabilitation programs shall also be qualified providers under
79	this section. In any benefit year, if partial hospitalization
80	services or a combination of inpatient and partial
81	hospitalization are utilized, the total benefits paid for all
82	such services shall not exceed the cost of 45 30 days of
83	inpatient hospitalization for psychiatric services, including
84	physician fees, which prevail in the community in which the
85	partial hospitalization services are rendered. If partial
86	hospitalization services benefits are provided beyond the limits
87	set forth in this paragraph, the durational limits, dollar
88	amounts, and coinsurance factors thereof need not be the same as
89	those applicable to physical illness generally.
90	(4)  In providing the benefits under this section, the
91	insurer or health maintenance organization may impose
92	appropriate financial incentives, peer review, utilization
93	requirements, and other methods used for the management of
94	benefits provided for other medical conditions, to reduce
95	service costs and utilization without compromising quality of
96	care.
97	(5)(3)  Insurers must maintain strict confidentiality
98	regarding psychiatric and psychotherapeutic records submitted to
99	an insurer for the purpose of reviewing a claim for benefits
100	payable under this section. These records submitted to an
101	insurer are subject to the limitations of s. 456.057, relating
102	to the furnishing of patient records.
103	(6)  This section does not apply with respect to a group
104	health plan, or health insurance coverage offered in connection
105	with a group health plan, if the application of this section to
106	such plan or coverage has caused an increase in the costs under
107	the plan or for such coverage of more than 2 percent, as
108	determined and certified by an independent actuary to the Office
109	of Insurance Regulation.
110	Section 2.  Paragraph (b) of subsection (8) of section
111	627.6675, Florida Statutes, is amended to read:
112	627.6675  Conversion on termination of
113	eligibility.--Subject to all of the provisions of this section,
114	a group policy delivered or issued for delivery in this state by
115	an insurer or nonprofit health care services plan that provides,
116	on an expense-incurred basis, hospital, surgical, or major
117	medical expense insurance, or any combination of these
118	coverages, shall provide that an employee or member whose
119	insurance under the group policy has been terminated for any
120	reason, including discontinuance of the group policy in its
121	entirety or with respect to an insured class, and who has been
122	continuously insured under the group policy, and under any group
123	policy providing similar benefits that the terminated group
124	policy replaced, for at least 3 months immediately prior to
125	termination, shall be entitled to have issued to him or her by
126	the insurer a policy or certificate of health insurance,
127	referred to in this section as a "converted policy." A group
128	insurer may meet the requirements of this section by contracting
129	with another insurer, authorized in this state, to issue an
130	individual converted policy, which policy has been approved by
131	the office under s. 627.410. An employee or member shall not be
132	entitled to a converted policy if termination of his or her
133	insurance under the group policy occurred because he or she
134	failed to pay any required contribution, or because any
135	discontinued group coverage was replaced by similar group
136	coverage within 31 days after discontinuance.
137	(8)  BENEFITS OFFERED.--
138	(b)  An insurer shall offer the benefits specified in s.
139	627.668 and the benefits specified in s. 627.669 if those
140	benefits were provided in the group plan.
141	Section 3.  Section 627.669, Florida Statutes, is repealed.
142	Section 4.  This act shall take effect January 1, 2010, and
143	shall apply to policies and contracts issued or renewed on or
144	after that date.

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