HB 149: "An Act relating to insurance coverage for treatment of mental illness and substance abuse; repealing provisions of ch. 8, SLA 1997, that terminates required mental health benefit coverage; and providing for an effective date."
00HOUSE BILL NO. 149 01 "An Act relating to insurance coverage for treatment of mental illness and 02 substance abuse; repealing provisions of ch. 8, SLA 1997, that terminates required 03 mental health benefit coverage; and providing for an effective date." 04 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 05 * Section 1. AS 21.36.090(d) is amended to read: 06 (d) Except to the extent necessary to comply with [AS 21.42.365 AND] 07 AS 21.56, a person may not practice or permit unfair discrimination against a person 08 who provides a service covered under a group health insurance policy that extends 09 coverage on an expense incurred basis, or under a group service or indemnity type 10 contract issued by a nonprofit corporation, if the service is within the scope of the 11 provider's occupational license. In this subsection, "provider" means a state licensed 12 physician, dentist, osteopath, optometrist, chiropractor, nurse midwife, advanced nurse 13 practitioner, naturopath, physical therapist, occupational therapist, marital and family 14 therapist, psychologist, psychological associate, or licensed clinical social worker, or
01 certified direct-entry midwife. 02 * Sec. 2. AS 21.54.150 is repealed and reenacted to read: 03 Sec. 21.54.150. Coverage for treatment of mental illness and substance 04 abuse. (a) A health care insurer that offers, issues for delivery, delivers, or renews 05 in this state a health care insurance plan providing coverage for five or more 06 employees of an employer in the group market shall provide a covered employee or 07 the employee's dependent coverage for treatment of mental illness and coverage for 08 treatment of substance abuse. 09 (b) A health care insurer that offers a health care insurance plan providing 10 coverage under this section may not 11 (1) require that a covered employee or the employee's dependent be 12 responsible for a deductible, coinsurance, or copayment that is different for the 13 determination of benefits relating to treating mental illness or substance abuse than for 14 the determination of benefits for treating another covered illness; 15 (2) use a different claim payment methodology in determining the 16 benefits relating to treating mental illness or substance abuse than that used in 17 determining the benefits for treating another covered illness; 18 (3) require prenotification of treatment or a second opinion unless the 19 requirement is applicable to other covered major illnesses; 20 (4) limit coverage by provisions of the insurance contract that are not 21 applicable to other covered major illnesses, including provisions concerning preexisting 22 illnesses or provisions requiring that the exact date of onset be known; 23 (5) limit treatment services under the insurance contract to either an 24 inpatient or outpatient service; 25 (6) deny reimbursement for actual services rendered solely because 26 treatment was interrupted or not completed; or 27 (7) impose annual or lifetime benefit limits, maximum out-of-pocket 28 expenses, day limits, or number-of-visit limits that are different for the determination 29 of benefits relating to treating mental illness or substance abuse than for the 30 determination of benefits relating to treating other covered illnesses. 31 (c) Notwithstanding (a) of this section, a health care insurer is not required to
01 provide the coverage specified in (a) of this section to an employer who employs fewer 02 than 20 permanent, full-time employees for each working day during each of at least 03 20 calendar workweeks in either the current calendar year or the preceding calendar 04 year, but shall offer that coverage to the employer as optional coverage. 05 (d) A health insurance plan that provides coverage for treatment of mental 06 illness through a managed care organization 07 (1) may not diminish or negate the provisions of this section; 08 (2) must provide timely and appropriate access to care; 09 (3) must provide adequate quantity, location, and specialty distribution 10 of health care providers; and 11 (4) may not use administrative or clinical protocols that reduce access 12 to medically necessary treatment for an insured. 13 (e) In this section, 14 (1) "mental illness" means a medical disorder described in the most 15 recent edition of the Diagnostic and Statistical Manual of Mental Disorders published 16 by the American Psychiatric Association, except for a medical disorder related to a 17 relationship, workplace problem, or other situation that has been classified in the 18 edition with a "V" code; 19 (2) "substance abuse" means an illness characterized by 20 (A) a physiological or psychological dependency, or both, on 21 alcoholic beverages or controlled substances as defined in AS 11.71.900; or 22 (B) habitual lack of self-control in using alcoholic beverages or 23 controlled substances to the extent that the person's health is substantially 24 impaired or the person's social or economic function is substantially disrupted; 25 (3) "treatment of mental illness" means inpatient or outpatient services 26 provided by 27 (A) a mental health professional as that term is defined in 28 AS 47.30.915; or 29 (B) a person with substantial experience in the field of mental 30 illness who is licensed under AS 08.29 or AS 08.63; 31 (4) "treatment of substance abuse" means medical care, including
01 detoxification, as an inpatient or outpatient at a facility that is either approved under 02 AS 47.37.140 or licensed for treatment of substance abuse. 03 * Sec. 3. AS 21.87.340 is amended to read: 04 Sec. 21.87.340. Other provisions applicable. In addition to the provisions 05 contained or referred to previously in this chapter, the following chapters and 06 provisions of this title also apply with respect to service corporations to the extent 07 applicable and not in conflict with the express provisions of this chapter and the 08 reasonable implications of the express provisions, and, for the purposes of the 09 application, the corporations shall be considered to be mutual "insurers": 10 (1) AS 21.03; 11 (2) AS 21.06; 12 (3) AS 21.09, except AS 21.09.090; 13 (4) AS 21.18.010; 14 (5) AS 21.18.030; 15 (6) AS 21.18.040; 16 (7) AS 21.18.120; 17 (8) AS 21.21.321; 18 (9) AS 21.36; 19 (10) AS 21.42.345 - 21.42.355 [21.42.365] and 21.42.375 - 21.42.395; 20 (11) AS 21.51.120; 21 (12) AS 21.53; 22 (13) AS 21.54; 23 (14) AS 21.56; 24 (15) AS 21.69.400; 25 (16) AS 21.69.520; 26 (17) AS 21.69.600, 21.69.620, and 21.69.630; 27 (18) AS 21.78; 28 (19) AS 21.89.040; 29 (20) AS 21.89.060; 30 (21) AS 21.90. 31 * Sec. 4. AS 21.42.365 is repealed.
01 * Sec. 5. Sections 116 and 122, ch. 81, SLA 1997, are repealed. 02 * Sec. 6. This Act takes effect July 1, 1999.