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SB 52: "An Act requiring health care insurers to provide coverage for treatment of mental health conditions, and requiring parity between health care insurance coverage for mental health, alcoholism, and substance abuse benefits and other medical care benefits; eliminating different treatment for mental health conditions from the minimum benefits of the state health insurance plan; removing an exclusion for mental health services or alcohol or drug abuse from the definition of 'basic health care services' in the law relating to health maintenance organizations; repealing a definition of 'mental health benefits' that excludes treatment of substance abuse or chemical dependency; and providing for an effective date."

00                             SENATE BILL NO. 52                                                                          
01 "An Act requiring health care insurers to provide coverage for treatment of mental                                      
02 health conditions, and requiring parity between health care insurance coverage for                                      
03 mental health, alcoholism, and substance abuse benefits and other medical care benefits;                                
04 eliminating different treatment for mental health conditions from the minimum benefits                                  
05 of the state health insurance plan; removing an exclusion for mental health services or                                 
06 alcohol or drug abuse from the definition of 'basic health care services' in the law                                    
07 relating to health maintenance organizations; repealing a definition of 'mental health                                  
08 benefits' that excludes treatment of substance abuse or chemical dependency; and                                        
09 providing for an effective date."                                                                                       
10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
11    * Section 1. AS 21.42.365 is amended to read:                                                                      
12            Sec. 21.42.365. Coverage for treatment of alcoholism or drug abuse. (a)                                    
01       Except for a fraternal benefit society, a health care insurer that offers, issues for                             
02       delivery, delivers, or renews in this state a health care insurance plan providing                                
03       coverage for five or more employees of an employer in the group market                                            
04                 (1)  shall offer a covered employee or the employee's dependent                                     
05       coverage for the treatment of alcoholism or drug abuse;                                                       
06                 (2)  may not                                                                                        
07                      (A)  establish a rate, term, or condition that places a greater                                
08            financial burden on an insured for diagnosis or treatment of alcoholism or                               
09            drug abuse than for other medical care; in this subparagraph, "rate, term,                               
10            or condition" means any lifetime or annual payment limit, deductible,                                    
11            copayment, coinsurance, cost-sharing requirement, out-of-pocket limit,                                   
12            limit on the frequency of treatment, number of visits, days of coverage, or                              
13            other similar limit on the scope or duration of treatment, or other                                      
14            financial component of health care insurance coverage that affects the                                   
15            insured;                                                                                                 
16                      (B)  use a different claim payment method to determine the                                     
17            benefits relating to treating alcoholism or drug abuse than that used in                                 
18            determining the benefits for other medical care;                                                         
19                      (C)  require prenotification of treatment or a second opinion                                  
20            unless the requirement is applicable to other medical care;                                              
21                      (D)  limit coverage by provisions of the insurance contract                                    
22            that are not applicable to other medical care, including provisions                                      
23            concerning preexisting illnesses or provisions requiring that the exact date                             
24            of onset be known;                                                                                       
25                      (E)  limit treatment services under the insurance contract to                                  
26            either an inpatient or outpatient service;                                                               
27                      (F)  exclude from coverage the cost of medically necessary                                     
28            treatment, including medical or psychiatric evaluation, activity or family                               
29            therapy, counseling, or prescription drugs or supplies received at an                                    
30            approved treatment facility; or                                                                          
31                      (G)  deny reimbursement for actual services rendered solely                                    
01            because treatment was interrupted or not completed.                                                      
02            (b)  In this section,                                                                                        
03                 (1)  "alcoholism or drug abuse" means an illness characterized by                                   
04                      (A) [(1)]  a physiological or psychological dependency, or both,                               
05            on alcoholic beverages or controlled substances as defined in AS 11.71.900; or                               
06                      (B) [(2)]  habitual lack of self-control in using alcoholic                                    
07            beverages or controlled substances to the extent that the person's health is                                 
08            substantially impaired or the person's social or economic function is                                        
09            substantially disrupted;                                                                                 
10                 (2)  "health care insurance plan" means, notwithstanding                                            
11       AS 21.54.500, a health care insurance policy or contract provided by a health                                 
12       care insurer;                                                                                                 
13                 (3)  "health care insurer" means, notwithstanding AS 21.54.500, a                                   
14       person transacting the business of health care insurance as defined in                                        
15       AS 21.12.050.                                                                                                 
16    * Sec. 2. AS 21.54.151 is repealed and reenacted to read:                                                          
17            Sec. 21.54.151. Mental health benefits. (a) A health care insurer that offers,                             
18       issues for delivery, delivers, or renews a health care insurance plan to an employer or                           
19       individual on a group or individual basis shall provide coverage for treatment of a                               
20       mental health condition.                                                                                          
21            (b)  A health care insurance plan may not establish a rate, term, or condition                               
22       that places a greater financial burden on an insured for diagnosis or treatment of a                              
23       mental health condition than for other medical care. In this subsection, "rate, term, or                          
24       condition" means any lifetime or annual payment limit, deductible, copayment,                                     
25       coinsurance, cost sharing requirement, out-of-pocket limit, limits on the frequency of                            
26       treatment, number of visits, days of coverage, or other similar limits on the scope or                            
27       duration of treatment, or other financial component of health care insurance coverage                             
28       that affects the insured.                                                                                         
29            (c)  In this section,                                                                                        
30                 (1)  "health care insurance plan" means, notwithstanding AS 21.54.500,                                  
31       a health care insurance policy or contract provided by a health care insurer;                                     
01                 (2)  "health care insurer" means, notwithstanding AS 21.54.500, a                                       
02       person transacting the business of health care insurance, as defined in                                           
03       AS 21.12.050(b);                                                                                                  
04                 (3)  "mental health condition" means a condition or disorder involving                                  
05       mental illness, including a mental health condition listed in the American Psychiatric                            
06       Association's Diagnostic and Statistical Manual of Mental Disorders.                                              
07    * Sec. 3. AS 21.54.500(27) is amended to read:                                                                     
08                 (27)  "preexisting condition exclusion" means a limitation or exclusion                                 
09       of benefits relating to a physical or mental health condition that was present before                         
10       the enrollment date, regardless of whether medical advice, diagnosis, care, or                                    
11       treatment was recommended or received before the enrollment date;                                                 
12    * Sec. 4. AS 21.55.110 is amended to read:                                                                         
13            Sec. 21.55.110. Minimum benefits of state health insurance plan. Except as                                 
14       provided in AS 21.55.120 - 21.55.140, the minimum standard benefits of a health                                   
15       insurance plan offered under AS 21.55.100(a) shall be benefits with a lifetime                                    
16       maximum of $1,000,000 for each individual for usual, customary, reasonable, or                                    
17       prevailing charges or, when applicable, the allowance agreed upon between a provider                              
18       and the plan administrator for charges. The minimum standard benefits of the plan                                 
19       must cover the following medical services performed for an individual covered by the                              
20       plan for the diagnosis or treatment of nonoccupational disease or nonoccupational                                 
21       injury:                                                                                                           
22                 (1)  hospital services;                                                                                 
23                 (2)  subject to the limitations of AS 21.36.090(d), professional services                               
24       that are rendered by a physician or by a registered nurse at the physician's direction,                           
25       other than services for [MENTAL OR] dental conditions;                                                            
26                 (3)  the diagnosis or treatment of mental health conditions, as defined                             
27       in regulations of the director [, RENDERED DURING THE YEAR ON OTHER                                               
28       THAN AN INPATIENT BASIS, UP TO A YEARLY MAXIMUM BENEFIT OF                                                        
29       $4,000];                                                                                                          
30                 (4)  legend drugs requiring a physician's prescription;                                                 
31                 (5)  services of a skilled nursing facility for not more than 120 days in a                             
01       policy year;                                                                                                      
02                 (6)  home health agency services up to a maximum of 270 visits in a                                     
03       calendar year if the services commence within seven days following confinement in a                               
04       hospital or skilled nursing facility of at least three consecutive days for the same                              
05       condition, except that in the case of an individual diagnosed by a physician as                                   
06       terminally ill with a prognosis of six months or less to live, the home health agency                             
07       services may commence irrespective of whether the covered person was previously                                   
08       confined or, if the covered person was confined, irrespective of the seven-day period,                            
09       and the yearly benefit for medical social services may not exceed $200;                                           
10                 (7)  hospice services for up to six months in a calendar year;                                          
11                 (8)  use of radium or other radioactive materials;                                                      
12                 (9)  outpatient chemotherapy;                                                                           
13                 (10)  oxygen;                                                                                           
14                 (11)  anesthetics;                                                                                      
15                 (12)  nondental prosthesis and maxillo-facial prosthesis used to replace                                
16       any anatomic structure lost during treatment for head and neck tumors or additional                               
17       appliances essential for the support of the prosthesis;                                                           
18                 (13)  rental, or purchase if purchase is more cost-effective [COST                                  
19       EFFECTIVE] than rental, of durable medical equipment that has no personal use in                                  
20       the absence of the condition for which it was prescribed;                                                         
21                 (14)  diagnostic x-rays and laboratory tests;                                                           
22                 (15)  oral surgery for excision of partially or completely unerupted                                    
23       impacted teeth or excision of a tooth root without the extraction of the entire tooth;                            
24                 (16)  services of a licensed physical therapist rendered under the                                      
25       direction of a physician;                                                                                         
26                 (17)  transportation by a local ambulance operated by licensed or                                       
27       certified personnel to the nearest health care institution for treatment of the illness or                        
28       injury and round trip transportation by air to the nearest health care institution for                            
29       treatment of the illness or injury if the treatment is not available locally; if the patient                      
30       is a child under 12 years of age, the transportation charges of a parent or legal                                 
31       guardian accompanying the child may be paid if the attending physician certifies the                              
01       need for the accompaniment;                                                                                       
02                 (18)  confinement in a licensed or certified facility established                                       
03       primarily for the treatment of alcohol or drug abuse, or in a part of a hospital used                             
04       primarily for this treatment, for a period of at least 45 days within any calendar year;                          
05                 (19)  alternatives to inpatient services as defined by the association in                               
06       the state plan benefits;                                                                                          
07                 (20)  second surgical opinions;                                                                         
08                 (21)  other services that are medically necessary in the treatment or                                   
09       diagnosis of an illness or injury as may be designated or approved by the director.                               
10    * Sec. 5. AS 21.55.120(b) is amended to read:                                                                      
11            (b)  A state plan other than a Medicare supplement plan shall require a                                      
12       maximum copayment of 20 percent for charges for all types of health care in excess of                             
13       the deductible [AND 50 PERCENT FOR SERVICES DESCRIBED IN                                                          
14       AS 21.55.110(3) IN EXCESS OF THE DEDUCTIBLE].                                                                     
15    * Sec. 6. AS 21.55.120(c) is amended to read:                                                                      
16            (c)  The sum of the deductible and copayments required in any calendar year                                  
17       under a plan may not exceed a maximum limit of $1,500 plus the deductible. Covered                                
18       expenses incurred after the applicable maximum limit has been reached shall be paid                               
19       at the rate of 100 percent of usual, customary, reasonable, or prevailing charges [,                              
20       EXCEPT THAT EXPENSES INCURRED FOR TREATMENT OF MENTAL AND                                                         
21       NERVOUS CONDITIONS SHALL BE PAID AT THE RATE OF 50 PERCENT].                                                      
22    * Sec. 7. AS 21.86.900(3) is amended to read:                                                                      
23                 (3)  "basic health care services" means emergency care, inpatient                                       
24       hospital and physician care, and outpatient medical services [, BUT DOES NOT                                      
25       INCLUDE MENTAL HEALTH SERVICES OR SERVICES FOR ALCOHOL OR                                                         
26       DRUG ABUSE];                                                                                                      
27    * Sec. 8. AS 21.97.900(30) is amended to read:                                                                     
28                 (30)  "medical care" means [AMOUNTS PAID FOR]                                                           
29                      (A)  diagnosis, care, mitigation, treatment, or prevention of                                      
30            disease, [OR AMOUNTS PAID] for the purpose of affecting any structure or                                     
31            function of the body, including mental health care or care for an alcoholism                             
01            or substance abuse disorder; and                                                                     
02                      (B)  transportation primarily for and essential to medical care                                    
03            described in (A) of this paragraph [; AND                                                                    
04                      (C)  INSURANCE COVERING MEDICAL CARE                                                               
05            DESCRIBED IN (A) AND (B) OF THIS PARAGRAPH];                                                                 
06    * Sec. 9. AS 21.54.500(21) and 21.54.500(22) are repealed.                                                         
07    * Sec. 10. The uncodified law of the State of Alaska is amended by adding a new section to                         
08 read:                                                                                                                   
09       APPLICABILITY. This Act applies to an insurance plan, contract, or policy that is                                 
10 offered, issued for delivery, delivered, or renewed on or after the effective date of this Act.                         
11    * Sec. 11. This Act takes effect July 1, 2011.