Bill Text: FL S1582 | 2016 | Regular Session | Introduced


Bill Title: Insurance Coverage for Mental and Nervous Disorders

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2016-03-11 - Died in Banking and Insurance [S1582 Detail]

Download: Florida-2016-S1582-Introduced.html
       Florida Senate - 2016                                    SB 1582
       
       
        
       By Senator Soto
       
       14-01204-16                                           20161582__
    1                        A bill to be entitled                      
    2         An act relating to insurance coverage for mental and
    3         nervous disorders; amending s. 627.668, F.S.;
    4         providing that certain coverage for mental and nervous
    5         disorders under specified health insurance policies or
    6         contracts is mandatory, rather than optional; revising
    7         requirements for inpatient benefits under such
    8         coverage to permit transferring unused benefits to
    9         outpatient or residential treatment benefits;
   10         redefining and revising limits for outpatient
   11         benefits; revising limits for partial hospitalization
   12         benefits; conforming provisions to changes made by the
   13         act; providing an effective date.
   14          
   15  Be It Enacted by the Legislature of the State of Florida:
   16  
   17         Section 1. Section 627.668, Florida Statutes, is amended to
   18  read:
   19         627.668 Mandatory Optional coverage for mental and nervous
   20  disorders required; exception.—
   21         (1) Every insurer, health maintenance organization, and
   22  nonprofit hospital and medical service plan corporation
   23  transacting group health insurance or providing prepaid health
   24  care in this state shall make available to the policyholder as
   25  part of the application, for an appropriate additional premium
   26  under a group hospital and medical expense-incurred insurance
   27  policy, under a group prepaid health care contract, and under a
   28  group hospital and medical service plan contract, the benefits
   29  or level of benefits specified in subsection (2) for the
   30  necessary care and treatment of mental and nervous disorders, as
   31  defined in the standard nomenclature of the American Psychiatric
   32  Association, subject to the right of the applicant for a group
   33  policy or contract to select any alternative benefits or level
   34  of benefits as may be offered by the insurer, health maintenance
   35  organization, or service plan corporation provided that, if
   36  alternate inpatient, outpatient, or partial hospitalization, or
   37  residential treatment benefits are selected, such benefits shall
   38  not be less than the level of benefits required under subsection
   39  (2) paragraph (2)(a), paragraph (2)(b), or paragraph (2)(c),
   40  respectively.
   41         (2) Under group policies or contracts, inpatient hospital
   42  benefits, partial hospitalization benefits, and outpatient
   43  benefits consisting of durational limits, dollar amounts,
   44  deductibles, and coinsurance factors shall not be less favorable
   45  than for physical illness generally, except that:
   46         (a) Inpatient benefits may be limited to not less than 45
   47  30 days per benefit year as defined in the policy or contract.
   48  If inpatient hospital benefits are provided beyond 45 30 days
   49  per benefit year, the durational limits, dollar amounts, and
   50  coinsurance factors thereto need not be the same as applicable
   51  to physical illness generally. However, the policy or contract
   52  must provide that unused inpatient hospital benefits may be
   53  transferred to either outpatient benefits or residential
   54  treatment benefits.
   55         (b) Outpatient benefits may be limited to 30 hours of
   56  $1,000 for consultations with a licensed physician, a
   57  psychologist licensed pursuant to chapter 490, a mental health
   58  counselor licensed pursuant to chapter 491, a marriage and
   59  family therapist licensed pursuant to chapter 491, and a
   60  clinical social worker licensed pursuant to chapter 491. If
   61  benefits are provided beyond 30 hours the $1,000 per benefit
   62  year, the durational limits, dollar amounts, and coinsurance
   63  factors thereof need not be the same as applicable to physical
   64  illness generally.
   65         (c) Partial hospitalization benefits shall be provided
   66  under the direction of a licensed physician. For purposes of
   67  this part, the term “partial hospitalization services” is
   68  defined as those services offered by a program that is
   69  accredited by an accrediting organization whose standards
   70  incorporate comparable regulations required by this state.
   71  Alcohol rehabilitation programs accredited by an accrediting
   72  organization whose standards incorporate comparable regulations
   73  required by this state or approved by the state and licensed
   74  drug abuse rehabilitation programs shall also be qualified
   75  providers under this section. In a given benefit year, if
   76  partial hospitalization services or a combination of inpatient
   77  and partial hospitalization are used, the total benefits paid
   78  for all such services may not exceed the cost of 121 30 days
   79  after inpatient hospitalization for psychiatric services,
   80  including physician fees, which prevail in the community in
   81  which the partial hospitalization services are rendered. If
   82  partial hospitalization services benefits are provided beyond
   83  the limits set forth in this paragraph, the durational limits,
   84  dollar amounts, and coinsurance factors thereof need not be the
   85  same as those applicable to physical illness generally.
   86         (3) Insurers must maintain strict confidentiality regarding
   87  psychiatric and psychotherapeutic records submitted to an
   88  insurer for the purpose of reviewing a claim for benefits
   89  payable under this section. These records submitted to an
   90  insurer are subject to the limitations of s. 456.057, relating
   91  to the furnishing of patient records.
   92         Section 2. This act shall take effect July 1, 2016.

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