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.