SS/SCS/HCS/HB 855 - This act changes the laws regarding insurance coverage for mental illness and chemical dependency.

TREATMENT OF ALCOHOLISM MANDATE - Under this act, the current provision regarding how health insurance policies must offer coverage for treatment of alcoholism is modified. The act modifies this provision by requiring all health plans or policies that are individually underwritten or that provide coverage for specific individuals and their family members to provide coverage for the treatment of alcoholism. Various group health insurance policies are excluded from this requirement. This provision applies to individual health plans or policies issued or renewed on or after January 1, 2005 (Section 376.779).

TREATMENT OF CHEMICAL DEPENDENCY - This act revises sections 376.810-376.814 which relate to the mandated offering of insurance coverage for the treatment of chemical dependency. This provision requires all health plans or policies that are individually underwritten or that provide coverage for specific individuals and their family members to offer coverage for the treatment of chemical dependency. Under this act, various group policies are excluded from this mandated offering.

This act revises the "Mental Health and Chemical Dependency Insurance Act"(Sections 376.825-376.840). All health plans or policies that are individually underwritten or that provide coverage for specific individuals and their family members can offer the coverage listed in this section. Various group policies are excluded from these provisions. These provisions shall apply to apply to applications for coverage on or after January 1, 2005 (Section 376.826 and 376.836).

MENTAL HEALTH PARITY - Section 376.1550 requires health carriers that offer health benefit plans in this state on or after January 1, 2005, to provide coverage for mental health conditions, excluding chemical dependency. Mental health conditions are defined as those listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, excluding chemical dependency.

Coverage for mental health conditions cannot have rates, terms, or conditions that place a greater financial burden on an insured for treatment of a mental health condition than for treatment of a physical health condition. Any deductible or out-of-pocket limits required by the health carrier or health benefit plan shall be comprehensive for coverage of all health conditions, whether physical or mental.

Health benefit plans may provide coverage for the treatment of mental health conditions through a managed care organization even if the health benefit plan does not otherwise provide for managed care. Treatment of a mental health condition through a managed care organization must comply with rules adopted by the Department of Insurance. Any coverage for chemical dependency offered pursuant to this section must comply with the requirements of sections 376.779, 376.810 to 376.814, and 376.825 to 376.836.

This provision does not apply to individually underwritten insurance policies, supplemental insurance policies, accident- only policies, specified disease policies, hospitalization- surgical care policies, or other supplemental policies as determined by the Director of the Department of Insurance.

An insurer may apply different limits or exclude entirely from coverage the following:

(1) Marital, family, educational, or training services unless medically necessary and clinically appropriate;

(2) Services rendered or billed by a school or halfway house;

(3) Care that is custodial in nature;

(4) Services and supplies that are not immediately nor clinically appropriate; or

(5) Treatments that are considered experimental.

EXEMPTION FROM MENTAL HEALTH PARITY - The act requires the Director of the Department of Insurance to grant a policyholder a waiver from the mental health parity insurance provision if the policyholder demonstrates to the Director by actual experience over a twenty-four consecutive month period that compliance with this provision has increased the cost of health insurance by an amount that results in a two percent increase in premiums.
LORIE TOWE