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House
File
58
-
Introduced
HOUSE
FILE
58
BY
JONES
A
BILL
FOR
An
Act
relating
to
insurance
coverage
for
the
treatment
of
1
eating
disorders.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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Section
1.
NEW
SECTION
.
514C.37
Eating
disorders
——
1
coverage.
2
1.
As
used
in
this
section,
unless
the
context
otherwise
3
requires:
4
a.
“Cost-sharing”
means
any
coverage
limit,
copayment,
5
coinsurance,
deductible,
or
other
out-of-pocket
expense
6
obligation
imposed
on
a
covered
person
by
a
policy,
contract,
7
or
plan
providing
for
third-party
payment
or
prepayment
of
8
health
or
medical
expenses.
9
b.
“Covered
person”
means
a
policyholder,
subscriber,
or
10
other
person
participating
in
a
policy,
contract,
or
plan
that
11
provides
for
third-party
payment
or
prepayment
of
health
or
12
medical
expenses.
13
c.
“Eating
disorder”
means
pica,
rumination
disorder,
14
avoidant
or
restrictive
food
intake
disorder,
anorexia
nervosa,
15
bulimia
nervosa,
binge
eating
disorder,
other
specified
feeding
16
or
eating
disorder,
and
any
other
eating
disorder
contained
17
in
the
most
recent
edition
of
the
diagnostic
and
statistical
18
manual
of
mental
disorders
as
published
by
the
American
19
psychiatric
association.
20
d.
“Facility”
means
an
institution
providing
health
care
21
services
or
a
health
care
setting,
including
but
not
limited
22
to
hospitals
and
other
licensed
inpatient
centers,
ambulatory
23
surgical
or
treatment
centers,
skilled
nursing
centers,
24
residential
treatment
centers,
diagnostic
centers,
laboratory
25
and
imaging
centers,
rehabilitation
centers,
and
other
26
therapeutic
settings.
27
e.
“Health
care
professional”
means
a
physician,
a
28
psychologist,
a
psychiatrist,
a
dietitian,
or
other
health
care
29
practitioner
licensed,
accredited,
registered,
or
certified
to
30
perform
specified
health
care
services
consistent
with
state
31
law.
32
f.
“Health
care
provider”
means
a
health
care
professional
33
or
a
facility.
34
g.
“Health
care
services”
means
services
for
the
diagnosis,
35
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prevention,
treatment,
cure,
or
relief
of
a
health
condition,
1
illness,
injury,
or
disease
including
services
for
mental
2
health
conditions,
illnesses,
injuries,
or
diseases.
“Health
3
care
services”
also
includes
dental
care
services.
4
h.
“Health
carrier”
means
the
same
as
defined
in
section
5
514J.102.
6
i.
“Treatment
plan”
means
a
plan
for
the
treatment
of
7
a
covered
person’s
eating
disorder
developed
by
a
health
8
care
professional
pursuant
to
a
comprehensive
evaluation
9
or
reevaluation
performed
in
consultation
with
the
covered
10
person
or
the
covered
person’s
representative.
The
plan
may
11
include
but
is
not
limited
to
cognitive
behavioral
therapy,
12
family-based
therapy,
group
cognitive
behavioral
therapy,
13
medical
nutrition
therapy,
prescription
drugs,
hospitalization,
14
day
treatment
programs,
residential
treatment
programs,
and
15
other
health
care
services.
16
2.
a.
Notwithstanding
the
uniformity
of
treatment
17
requirements
of
section
514C.6,
a
health
carrier
that
offers
18
individual,
group,
or
small
group
contracts,
policies,
or
19
plans
in
this
state
that
provide
for
third-party
payment
or
20
prepayment
of
health
or
medical
expenses
shall
offer
coverage
21
for
the
treatment
of
eating
disorders
including
all
of
the
22
following:
23
(1)
Health
care
services
pursuant
to
a
covered
person’s
24
treatment
plan.
25
(2)
Health
care
services
pursuant
to
a
covered
person’s
26
treatment
plan
that
are
provided
to
the
covered
person
27
out-of-network
or
out-of-state
if
such
health
care
services
are
28
unavailable
in
this
state
and
are
determined
to
be
medically
29
necessary
by
the
covered
person’s
health
care
provider.
30
b.
Coverage
required
under
this
section
shall
not
be
less
31
favorable
than
coverage
a
health
carrier
offers
for
general
32
physical
illness.
33
c.
Cost-sharing
requirements
imposed
for
coverage
34
required
under
this
section
shall
not
be
less
favorable
than
35
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cost-sharing
requirements
imposed
by
a
health
carrier
for
1
general
physical
illness.
2
3.
a.
This
section
applies
to
the
following
classes
of
3
third-party
payment
provider
contracts,
policies,
or
plans
4
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
5
state
on
or
after
January
1,
2026:
6
(1)
Individual
or
group
accident
and
sickness
insurance
7
providing
coverage
on
an
expense-incurred
basis.
8
(2)
An
individual
or
group
hospital
or
medical
service
9
contract
issued
pursuant
to
chapter
509,
514,
or
514A.
10
(3)
An
individual
or
group
health
maintenance
organization
11
contract
regulated
under
chapter
514B.
12
(4)
A
plan
established
for
public
employees
pursuant
to
13
chapter
509A.
14
(5)
The
medical
assistance
program
under
chapter
249A
15
including
all
managed
care
organizations
acting
pursuant
to
a
16
contract
with
the
department
of
health
and
human
services
to
17
administer
the
medical
assistance
program.
18
b.
This
section
shall
not
apply
to
accident-only,
19
specified
disease,
short-term
hospital
or
medical,
hospital
20
confinement
indemnity,
credit,
dental,
vision,
Medicare
21
supplement,
long-term
care,
basic
hospital
and
medical-surgical
22
expense
coverage
as
defined
by
the
commissioner,
disability
23
income
insurance
coverage,
coverage
issued
as
a
supplement
24
to
liability
insurance,
workers’
compensation
or
similar
25
insurance,
or
automobile
medical
payment
insurance.
26
4.
The
commissioner
of
insurance
shall
adopt
rules
pursuant
27
to
chapter
17A
to
administer
this
section.
28
EXPLANATION
29
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
30
the
explanation’s
substance
by
the
members
of
the
general
assembly.
31
This
bill
relates
to
insurance
coverage
for
eating
32
disorders.
“Eating
disorder”
is
defined
in
the
bill
as
pica,
33
rumination
disorder,
avoidant
or
restrictive
food
intake
34
disorder,
anorexia
nervosa,
bulimia
nervosa,
binge
eating
35
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4
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58
disorder,
other
specified
feeding
or
eating
disorder,
and
any
1
other
eating
disorder
contained
in
the
most
recent
edition
of
2
the
diagnostic
and
statistical
manual
of
mental
disorders
as
3
published
by
the
American
psychiatric
association.
4
The
bill
requires
a
policy,
contract,
or
plan
providing
for
5
third-party
payment
or
prepayment
of
health
or
medical
expenses
6
to
provide
coverage
for
health
care
services
(services)
7
pursuant
to
a
covered
person’s
treatment
plan
(plan),
and
8
services
pursuant
to
a
covered
person’s
plan
that
are
provided
9
to
the
covered
person
out-of-network
or
out-of-state
if
such
10
services
are
unavailable
in
this
state
and
are
determined
11
to
be
medically
necessary
by
the
covered
person’s
health
12
care
provider.
“Treatment
plan”
is
defined
in
the
bill
13
as
a
plan
for
the
treatment
of
a
covered
person’s
eating
14
disorder
developed
by
a
health
care
professional
pursuant
15
to
a
comprehensive
evaluation
or
reevaluation
performed
in
16
consultation
with
the
covered
person
or
the
covered
person’s
17
representative.
The
plan
may
include
but
is
not
limited
to
18
cognitive
behavioral
therapy,
family-based
therapy,
group
19
cognitive
behavioral
therapy,
medical
nutrition
therapy,
20
prescription
drugs,
hospitalization,
day
treatment
programs,
21
residential
treatment
programs,
and
other
health
care
services.
22
The
bill
applies
to
third-party
payment
providers
enumerated
23
in
the
bill,
including
the
medical
assistance
program
(program)
24
under
Code
chapter
249A
and
managed
care
organizations
acting
25
pursuant
to
a
contract
with
the
department
of
health
and
human
26
services
to
administer
the
program.
The
bill
specifies
the
27
types
of
specialized
health-related
insurance
which
are
not
28
subject
to
the
bill.
29
The
commissioner
of
insurance
is
required
to
adopt
rules
to
30
administer
the
bill.
31
The
bill
applies
to
third-party
payment
provider
contracts,
32
policies,
or
plans
delivered,
issued
for
delivery,
continued,
33
or
renewed
in
this
state
on
or
after
January
1,
2026.
34
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