- House Committee Substitute -

HCS/SCS/SBs 1061 & 1062 - This act makes changes in the law relating to Health Services Corporations.

DEEMED APPROVAL (Sections 354.085 and 354.405) - This act holds that whenever a health service corporation submits a policy form to the Director of Insurance, and the Director does not disapprove the form within 45 days (up from 30 days), the form is deemed approved and is not subject to disapproval for 12 months. If during the 12-month period the Director determines that any provision of the policy is contrary to statute, the Director shall notify the health service corporation of the specific provision that is contrary to statute and may request that it file an amendment within 30 days to modify the provision so that it conforms with the statute. Upon approval of the amendment by the Director, the health services corporation shall issue a copy of the amendment to each individual or entity in which the deemed policy form was previously issued. The health services corporation may issue the conforming amendment to the group contract holder so that it can distribute the amendment to its members or by including a copy of the amendment in the health services corporation's next scheduled mailing to its members. Such amendment have the force and effect as if the amendment was in the original filing or policy.

A similar procedure shall also be followed when an HMO files certain documents (pertaining to its certificate of authority with the Department of Insurance) (Section 354.405).

NETWORK ADEQUACY - This act deems a managed care plan's network as adequate if the managed care plan is:

(1) A Medicare + Choice coordinated care plan offered by the health carrier pursuant to a contract with the federal centers for medicare and medicaid services;

(2) A managed care plan that has been accredited by National Committee for Quality Assurance (NCQA), and such accreditation is in effect at the time the access plan is filed; or

(3) The managed care plan's network has been accredited by the Joint Commission on the Accreditation of Health Organizations at a level of accreditation without type I recommendations or better. If the accreditation applies only to a portion of the managed care plan's network, only the accredited portion will be deemed adequate (Section 354.603).

INTERNET FORMS - This act allows any managed care entity to provide documents and materials to an enrollee via the entity's Internet site, instead of in printed form, upon securing a waiver from the enrollee. The enrollee may revoke the waiver at any time. This portion of the act is identical to SB 1004 (2002) (section 354.1450).

MENTAL HEALTH PARITY (Sections 376.1550) - This act requires health carriers that offer health benefit plans in this state on or after January 1, 2003, to provide coverage for mental health conditions. Mental health conditions are defined as conditions or disorders, excluding chemical dependence, defined by categories listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders. Coverage for mental health conditions cannot have rates, terms, or conditions that place a greater financial burden on an insured for mental health condition than for physical health condition. This mandated benefit shall not apply to supplemental insurance policies, life care contracts, accident-only policies, specified disease policies or other specific policies. The act also repeals various provisions of law related to mental health coverage. For example, the provision which places annual and lifetime limits on alcohol and drug abuse treatment services (Section 376.827) is repealed. These provisions are similar to those contained in HB 1440 (2002).

STEPHEN WITTE