SENATE BILL NO. 219
INTRODUCED BY M. WATERMAN, C. HIBBARD, D. ADAMS, C. AHNER, B. BARNHART,
S. BARTLETT, J. BOHLINGER, R. BUZZAS, C. CHRISTIAENS, B. CRIPPEN, R. DALE, S. DOHERTY,
D. ECK, J. ELLINGSON, D. EWER, S. GALLUS, K. GILLAN, M. GUGGENHEIM, M. HALLIGAN,
D. HARGROVE, G. JERGESON, T. KEATING, B. KEENAN, R. LENHART, D. MAHLUM, J. MANGAN,
G. MASOLO, T. SCHMIDT, S. STANG, J. TESTER, B. THOMAS, J. WELLS, B. WILSON, C. YOUNKIN, C. WILLIAMS, D. SHEA
AN ACT DEFINING "SEVERE MENTAL ILLNESS"; PROVIDING PARITY OF INSURANCE COVERAGE FOR SEVERE MENTAL ILLNESS; AMENDING SECTIONS 33-22-701, 33-22-702, 33-22-704, AND 33-31-111, MCA; AND PROVIDING A DELAYED EFFECTIVE DATE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
Section 1. Coverage for severe mental illness -- definition. (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 a level of benefits for the necessary care and treatment of severe mental illness, as defined in subsection (6), that is no less favorable than that level provided for other physical illness generally. Benefits for treatment of severe mental illness may be subject to managed care provisions contained in the policy or certificate.
(2) Benefits provided pursuant to subsection (1) include but are not limited to:
(a) inpatient hospital services;
(b) outpatient services;
(c) rehabilitative services;
(d) medication;
(e) services rendered by a licensed physician, licensed advanced practice registered nurse with a specialty in mental health, licensed social worker, licensed psychologist, or licensed professional counselor when those services are part of a treatment plan recommended and authorized by a licensed physician; and
(f) services rendered by a licensed advanced practice registered nurse with prescriptive authority and specializing in mental health.
(3) Benefits provided pursuant to this section must be included when determining maximum lifetime benefits, copayments, and deductibles.
(4) (a) This section applies to 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; and
(v) health maintenance organizations.
(b) This section does not apply to the following coverages:
(i) blanket;
(ii) short-term travel;
(iii) accident only;
(iv) limited or specific disease;
(v) Title XVIII of the Social Security Act (medicare); or
(vi) any other similar coverage under state or federal government plans.
(5) This section does not limit benefits for an illness or condition that does not constitute a severe mental illness, as defined in subsection (6), but that does constitute a mental illness, as defined in 33-22-702.
(6) As used in this section, "severe mental illness" means the following disorders as defined by the American psychiatric association:
(a) schizophrenia;
(b) schizoaffective disorder;
(c) bipolar disorder;
(d) major depression;
(e) panic disorder;
(f) obsessive-compulsive disorder; and
(g) autism.
Section 2. Section 33-22-701, MCA, is amended to read:
"33-22-701. Scope of part -- purpose -- exception. The Except as provided in [section 1], the provisions of this part
apply to all group policies of accident and health insurance and group subscriber contracts for the care and treatment of
mental illness, alcoholism, and drug addiction offered to Montana residents by insurers, health service corporations, and all
employees' health and welfare funds that provide accident and health insurance benefits to residents of this state. It is the
purpose of this part to preserve the rights of the consumer to have such this coverage according to his the consumer's
medical and economic needs."
Section 3. Section 33-22-702, MCA, is amended to read:
"33-22-702. Definitions. For purposes of this part, the following definitions apply:
(1) "Chemical dependency treatment center" means a treatment facility that:
(a) provides a program for the treatment of alcoholism or drug addiction pursuant to a written treatment plan approved and monitored by a physician or chemical dependency counselor certified by the state; and
(b) is licensed or approved as a treatment center by the department of public health and human services under 53-24-208.
(2) "Inpatient benefits" are as set forth in 33-22-705.
(3) "Mental health treatment center" means a treatment facility organized to provide care and treatment for mental illness through multiple modalities or techniques pursuant to a written treatment plan approved and monitored by an interdisciplinary team, including a licensed physician, psychiatric social worker, and psychologist, and a treatment facility that is:
(a) licensed as a mental health treatment center by the state;
(b) funded or eligible for funding under federal or state law; or
(c) affiliated with a hospital under a contractual agreement with an established system for patient referral.
(4) (a) "Mental illness" means a clinically significant behavioral or psychological syndrome or pattern that occurs in a person and that is associated with:
(i) present distress or a painful symptom;
(ii) a disability or impairment in one or more areas of functioning; or
(iii) a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.
(b) Mental illness must be considered as a manifestation of a behavioral, psychological, or biological dysfunction in a person.
(c) Mental illness does not include:
(i) a developmental disorder;
(ii) a speech disorder;
(iii) a psychoactive substance use disorder;
(iv) an eating disorder, except for bulimia and anorexia nervosa; or
(v) an impulse control disorder, except for intermittent explosive disorder and trichotillomania; or
(vi) a severe mental illness as provided in [section 1].
(5) "Outpatient benefits" are as set forth in 33-22-705."
Section 4. Section 33-22-704, MCA, is amended to read:
"33-22-704. Applicability. This Except as provided in [section 1], this part applies to policies, contracts, or any
employees' health and welfare fund that provides accident and health insurance benefits, established, delivered, issued for
delivery, or renewed after September 30, 1987, but does not apply to blanket, short-term travel, accident-only, limited or
specified disease, individual conversion policies or contracts, or to policies or contracts designed for issuance to persons
eligible for coverage under Title XVIII of the Social Security Act, known as medicare, or any other similar coverage under
state or federal governmental plans."
Section 5. Section 33-31-111, MCA, is amended to read:
"33-31-111. Statutory construction and relationship to other laws. (1) Except as otherwise provided in this chapter, the insurance or health service corporation laws do not apply to any health maintenance organization authorized to transact business under this chapter. This provision does not apply to an insurer or health service corporation licensed and regulated pursuant to the insurance or health service corporation laws of this state except with respect to its health maintenance organization activities authorized and regulated pursuant to this chapter.
(2) Solicitation of enrollees by a health maintenance organization granted a certificate of authority or its representatives is not a violation of any law relating to solicitation or advertising by health professionals.
(3) A health maintenance organization authorized under this chapter is not practicing medicine and is exempt from Title 37, chapter 3, relating to the practice of medicine.
(4) This chapter does not exempt a health maintenance organization from the applicable certificate of need requirements under Title 50, chapter 5, parts 1 and 3.
(5) This section does not exempt a health maintenance organization from the prohibition of pecuniary interest under 33-3-308 or the material transaction disclosure requirements under 33-3-701 through 33-3-704. A health maintenance organization must be considered an insurer for the purposes of 33-3-308 and 33-3-701 through 33-3-704.
(6) This section does not exempt a health maintenance organization from:
(a) prohibitions against interference with certain communications as provided under chapter 1, part 8;
(b) the provisions of Title 33, chapter 22, part 19;
(c) the requirements of 33-22-134 and 33-22-135; or
(d) network adequacy and quality assurance requirements provided under chapter 36.
(7) Sections 33-22-141, 33-22-142, 33-22-246, 33-22-247, 33-22-514, 33-22-523, 33-22-524, and 33-22-526, and
[section 1] apply to health maintenance organizations."
Section 6. 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].
Section 7. Severability. If a part of [this act] is invalid, all valid parts that are severable from the invalid part remain in effect. If a part of [this act] is invalid in one or more of its applications, the part remains in effect in all valid applications that are severable from the invalid applications.
Section 8. Saving clause. [This act] does not affect rights and duties that matured, penalties that were incurred, or proceedings that were begun before [the effective date of this act].
Section 9. Effective date. [This act] is effective January 1, 2000, for all policies or certificates issued or renewed on or after that date.
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Latest Version of SB 219 (SB0219.ENR)
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