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Legislation Signed into Law

2019

Primary Focus: Medical Management Limitation; Medicaid
Title/Description: An act relating to prior authorization for medication-assisted treatment under the Medicaid program
Citation: n/a
Summary: This Act requires that the state Medicaid fee-for-service and managed care programs offer at least one form of MAT without prior authorization.
Effective Date: n/a
Notes: Enacted through HF 623

2018

Primary Focus: Mandated Benefit: Provider
Title/Description: Services provided by certain licensed master social workers, licensed mental health counselors, and licensed marital and family therapists
Citation: Iowa Code § 514C.32
Summary: Any policy or contract providing for third-party payment of health or medical expenses shall include a provision to pay for necessary behavioral health services provided by a licensed master social worker, a licensed mental health counselor, and a licensed marital and family therapist. Practice or supervisory restrictions for such professionals cannot be inconsistent with or more restrictive than the authority already granted by law. The act does not require health maintenance organizations or preferred provider organizations to provide payment for services provided by such professionals while they are under the supervision of another professional, unless the supervisor has entered into a contract to do so.
Effective Date: July 1, 2018
Notes: Enacted through SF 2418 (87th General Assembly)

Primary Focus: Mandated Benefit: Telehealth
Title/Description: Health care services delivered by telehealth – coverage
Citation: Iowa Code § 514C.32
Summary: Any policy or contract providing for third-party payment of health or medical expenses shall not discriminate between coverage benefits for health care services that are provided in person and the same health care services that are delivered through telehealth.
Effective Date: July 1, 2018
Notes: Enacted through SF 2305 (87th General Assembly)

Primary Focus: Mandated Benefit: Provider
Title/Description: Services provided by provisionally licensed psychologists
Citation: Iowa Code § 514C.33
Summary: Any policy or contract providing for third-party payment of health or medical expenses shall include a provision to pay for necessary behavioral health services provided by a person who holds a provisional license to practice psychology and who practices under the supervision of a qualified supervisor. Practice or supervisory restrictions for such professionals cannot be inconsistent with or more restrictive than the authority already granted by law. The act does not require health maintenance organizations or preferred provider organizations to provide payment for services provided by such professionals while they are under the supervision of another professional, unless the supervisor has entered into a contract to do so.
Effective Date: July 1, 2018
Notes: Enacted the SF 2418 (87th General Assembly)

2015-2016

SF 505
Introduced: 5/2015
Sponsor: Sen. Reagan
Status: Signed into law 7/2015
Summary: This is an appropriations bill that changes the section of state law about autism services. It changes the definition of autism provider to include assistant behavior analyst in addition to behavior analyst. It also extends the age from nine to fifteen for eligible individuals who can access autism treatment services through the medical assistants program if their household income does not exceed 400% of the federal poverty line.

2011

Primary Focus: Mandated Benefit: Provider
Title/Description: Autism spectrum disorders coverage
Citation: Iowa Code § 514C.28
Summary: Any policy or contract providing for third-party payment of health or medical expenses shall include a provision to provide coverage for covered individuals under twenty-one years of age for the diagnostic assessment of autism spectrum disorders and for the treatment of autism spectrum disorders. Coverage is required in a maximum benefit amount of not more than $36,000 per year (as adjusted every year), but shall not be subject to any limits on the number of visits to an autism service provider for treatment of autism spectrum disorders.
Effective Date: January 1, 2011
Notes: Enacted through HF 2531 (83rd General Assembly)

2009-2010

HF 2201
Introduced: 2/2010
Sponsor: Committee on Commerce
Status: Signed into law 4/2010
Summary: This comprehensive bill addressed many issues, and added a section to the state insurance law about behavioral health coverage for military veterans. This section is summarized at the bottom of this page under “Iowa Parity Law.”
HF 2531
Introduced: 3/2010
Sponsor: Unknown
Status: Signed into law 4/2010
Summary: This comprehensive bill addressed many issues and added a section to the state insurance law about autism coverage. This section is summarized at the bottom of this page under “Iowa Parity Law.”

Iowa Parity Law

There are three sections of the state insurance law relevant to parity:

Mental Health Coverage

This section of the insurance law (514C.22) requires large employer fully-insured plans to cover services for certain conditions. Small employer fully-insured plans are not required to cover any mental health treatment, but if they do they must cover services for these certain conditions as well. The conditions are:

  • Schizophrenia
  • Bipolar disorders
  • Major depressive disorders
  • Schizo-affective disorders
  • Obsessive compulsive disorders
  • Pervasive developmental disorders
  • Autistic disorders

The Commissioner of the Iowa Insurance Division is required to define these conditions by referencing the Diagnostic and Statistical Manual of Mental Disorders (DSM). Pervasive developmental disorders and autistic disorders are covered in much more detail by another section of the law (summarized below under “Autism”).

Plans cannot use annual maximums and lifetime maximums for mental health coverage if they are not in place for other medical coverage. If they do have annual and lifetime maximums in place for other medical coverage, the ones used for mental health services cannot be less than the ones for other medical coverage.

Plans must cover at least 30 days of inpatient care and 52 visits for outpatient care. Deductibles, copayments, and coinsurance must be the same for mental health services and other medical services.

Plans are specifically exempted from covering the following:

  • “Marital, family, educational, developmental, or training services”
  • “Care that is substantially custodial in nature”
  • “Services and supplies that are not medically necessary or clinically appropriate”
  • “Experimental treatments”

Behavioral Health Coverage for Veterans

This section of the insurance law (514C.27) is identical to what is described above except that it requires plans to cover services for all mental health conditions and substance use disorders for veterans of the United States Armed Forces. Mental health conditions are defined as they are in the DSM, while substance use disorder is defined as “a pattern of pathological use of alcohol or a drug that causes impairment in social or occupational functioning, or that produces physiological dependency evidenced by physical tolerance or by physical symptoms when the alcohol or drug is withdrawn.”

Autism

This section of the insurance law (514C.28) requires state employee plans to cover autism services for children and young adults up through age 20.

Plans must cover an annual maximum of $36,000 that can be adjusted for inflation each year. Plans are not allowed to limit the number of outpatient visits unless the annual maximum is exceeded.

Deductibles, copayments, and coinsurance must be the same as those used for other medical services.

Insurance plans are allowed to review a child’s treatment plan once every six months, and the validity of a diagnosis of autism spectrum disorder can be reviewed once a year.

The following are listed as accepted treatments for autism:

  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Rehabilitative care (includes applied behavior analysis )
  • Therapeutic care

Autism spectrum disorder is defined as autistic disorder, Asperger’s disorder, and pervasive developmental disorder not otherwise specified, but the Commissioner is allowed to define autism spectrum disorder as it is defined in the “most recent edition” of the DSM.

Get Support

Iowa Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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