Download Zipped Amended WP 8.0 HB0159.ZIP 8,917 Bytes
[Introduced][Status][Bill Documents][Fiscal Note][Bills Directory]

H.B. 159

             1     

MENTAL HEALTH INSURANCE PARITY

             2     
1999 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Sponsor: Judy Ann Buffmire

             5      AN ACT RELATING TO INSURANCE; REQUIRING THAT HEALTH INSURANCE
             6      POLICIES COVER MENTAL HEALTH CONDITIONS ON THE SAME BASIS AS PHYSICAL
             7      HEALTH CONDITIONS; PERMITTING MENTAL HEALTH SERVICES TO BE PROVIDED
             8      THROUGH MANAGED CARE; REQUIRING THAT SERVICES BE PROVIDED BY
             9      LICENSED PERSONS AND FACILITIES; EXTENDING RULEMAKING AUTHORITY TO
             10      THE COMMISSIONER OF INSURANCE; AND PROVIDING AN EFFECTIVE DATE.
             11      This act affects sections of Utah Code Annotated 1953 as follows:
             12      ENACTS:
             13          31A-22-625, Utah Code Annotated 1953
             14      Be it enacted by the Legislature of the state of Utah:
             15          Section 1. Section 31A-22-625 is enacted to read:
             16          31A-22-625. Coverage of mental health conditions.
             17          (1) This section applies h TO STATE EMPLOYEE HEALTH CARE PLANS, BY CONTRACT,
             17a      AND h generally to health insurance policies and health maintenance
             18      organization contracts.
             19          (2) A policy or contract:
             20          (a) shall provide coverage for the treatment of mental health conditions; and
             21          (b) may not establish any rate, term, or condition that places a greater financial burden on
             22      an insured for the treatment of a mental health condition than for the treatment of a covered
             23      physical health condition.
             24          (3) Expenditures for mental health conditions and physical health conditions shall count
             25      equally toward any deductible or out-of-pocket limit.
             26          (4) A policy or contract may provide coverage for the treatment of mental health
             27      conditions through a managed care organization or system, regardless of whether the policy or


             28      contract uses a managed care organization or system for the treatment of physical health
             29      conditions, provided that the managed care organization or system is in compliance with the rules
             30      adopted by the commissioner pursuant to Subsection (7).
             31          (5) (a) A policy or contract shall be in compliance with this section if the policy or contract
             32      offers at least one coverage option that places no greater financial burden on the insured for the
             33      treatment of mental health conditions than for the treatment of physical health conditions.
             34          (b) The commissioner may disapprove any policy or contract that the commissioner
             35      determines to be inconsistent with the purposes of this section.
             36          (6) To be eligible for coverage under this section treatment for a mental health condition
             37      must be rendered:
             38          (a) by a h [ mental health professional ] PERSON h licensed h AS A MENTAL HEALTH
             38a      PROFESSIONAL h pursuant to Title 58, Chapter 60, Mental
             39      Health Professional Practice Act; h [ or ]
             39a          (b) BY A PERSON LICENSED AS A PHYSICIAN AND SURGEON, OSTEOPATHIC PHYSICIAN
             39b      AND SURGEON, NURSE, OR PSYCHOLOGIST UNDER TITLE 58, OCCUPATIONS AND PROFESSIONS,
             39c      CONSISTENT WITH SUBSECTION 58-60-107(1); OR h
             40           h [ (b) ] (c) h in a health care facility licensed to provide mental health service pursuant to
             40a      Title 26,
             41      Chapter 21, Health Care Facility Licensing and Inspection Act, or Title 62A, Chapter 2, Licensure
             42      of Programs and Facilities, that provides a program for the treatment of a mental health condition
             43      pursuant to a written plan.
             44          (7) The commissioner shall adopt rules to ensure that:
             45          (a) timely and appropriate access to mental health treatment is available; and
             46          (b) administrative and clinical protocols do not serve to reduce access to medically
             47      necessary mental health treatment for any insured.
             48          (8) As used in this section:
             49          (a) "Mental health condition" means any condition or disorder involving mental illness that
             50      falls under any of the diagnostic categories listed in the mental disorders section of the
             51      International Classification of Diseases, as periodically revised h , EXCEPT THAT "MENTAL HEALTH
             51a      CONDITION" DOES NOT INCLUDE THE FOLLOWING WHEN DIAGNOSED AS THE PRIMARY OR
             51b      SUBSTANTIAL REASON OR NEED FOR TREATMENT:
             51c          (i) MARITAL OR FAMILY PROBLEM;
             51d          (ii) SOCIAL, OCCUPATIONAL, RELIGIOUS, OR OTHER SOCIAL MALADJUSTMENT;
             51e          (iii) CONDUCT DISORDER;
             51f          (iv) CHRONIC ADJUSTMENT DISORDER; h


             51g           h (v) PSYCHOSEXUAL DISORDER;
             51h          (vi) CHRONIC ORGANIC BRAIN SYNDROME;
             51i          (vii) PERSONALITY DISORDER;
             51j          (viii) DEVELOPMENTAL DISORDER OR LEARNING DISABILITY; OR
             51k          (ix) MENTAL RETARDATION h .
             52          (b) "Rate, term, or condition" means any lifetime or annual payment limits, deductibles,
             53      copayments, coinsurance, and any other cost-sharing requirements, out-of-pocket limits, visit
             54      limits, or any other financial component of health insurance coverage that affects the insured.
             55          Section 2. Effective date.
             56          This act takes effect on July 1, 2000.





Legislative Review Note
    as of 1-28-99 1:43 PM


A limited legal review of this legislation raises no obvious constitutional or statutory concerns.

Office of Legislative Research and General Counsel


[Bill Documents][Bills Directory]