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SENATE BILL NO. 209
INTRODUCED BY C. CHRISTIAENS
A BILL FOR AN ACT ENTITLED: "AN ACT PROVIDING PARITY OF INSURANCE COVERAGE FOR MENTAL HEALTH CONDITIONS; AND PROVIDING A DELAYED EFFECTIVE DATE."
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
NEW SECTION. Section 1. Coverage for mental health. (1) A policy or certificate of health insurance or disability insurance that is delivered, issued for delivery, renewed, extended, or modified in this state must provide coverage for treatment for mental conditions and may not establish any rate, term, or condition that places a greater financial burden on an insured or covered person for access to treatment a for mental health condition than for access to treatment for a physical health condition.
(2) (a) A policy for health or disability insurance and a membership contract of a health service corporation may not require mental health services to satisfy a definition of "medically necessary care", "medical necessity", or a similar term that is more restrictive with respect to mental health conditions than the definition provided in subsection (2)(b).
(b) "Medically necessary care" means health care services that are appropriate, in terms of type, frequency, level, setting, and duration, to the insured's or covered person's diagnosis or condition and diagnostic testing and preventive services. Medically necessary care must be consistent with generally accepted practice parameters as determined by health care providers in the same or similar general specialty that typically manages the mental health condition, procedure, or treatment at issue and must:
(i) help restore or maintain the insured's or covered person's mental health; or
(ii) prevent deterioration of the insured's or covered person's mental health condition.
(3) For the purposes of this section, "mental health condition" means any condition or disorder involving mental illness or alcohol or substance abuse that falls under any of the diagnostic categories lists in the mental disorders section of the International Classification of Diseases, as periodically revised.
(4) For the purposes of this section, "rate, term, or condition" means any lifetime or annual payment limits, deductibles, copayments, coinsurance, or any other cost-sharing requirements, out-of-pocket limits, visit limits, or any other financial component of a policy or certificate of health insurance or disability insurance that affects the insured or covered person.
(5) (a) This section applies to mental health service benefits provided by:
(i) individual and group health and disability insurance;
(ii) individual and group hospital or medical expense insurance;
(iii) medical subscriber contracts;
(iv) membership contracts of a health service corporation;
(v) health maintenance organizations.
(b) This section does not apply to the following coverages:
(ii) short-term travel;
(iii) accident only;
(iv) limited or specific disease;
(v) Title XVIII of the Social Security Act (medicare);
(vi) any other similar coverage under state or federal government plans.
NEW SECTION. Section 2. Effective date. [This act] is effective January 1, 2000, for all policies or certificates issued or renewed on or after that date.
NEW SECTION. Section 3. Codification instruction. [Section 1] is intended to be codified as an integral part of Title 33, chapter 22, part 7, and the provisions of Title 33, chapter 22, part 7, apply to [section 1].
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Latest Version of SB 209 (SB0209.01)
Processed for the Web on January 14, 1999 (5:37PM)
New language in a bill appears underlined, deleted material appears stricken.
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Status of this Bill| 1999 Session | Leg. Branch Home
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