MISSISSIPPI LEGISLATURE

2000 Regular Session

To: Insurance

By: Senator(s) Kirby

AN ACT TO REQUIRE CERTAIN HEALTH INSURANCE POLICIES TO OFFER AN OPTIONAL PROVISION PROVIDING COVERAGE OF SEVERE MENTAL ILLNESS; TO DEFINE THE TERM "SEVERE MENTAL ILLNESS"; TO PROVIDE FOR APPLICABILITY OF THE ACT; TO PROVIDE THAT A POLICY SHALL BE IN COMPLIANCE WITH THE ACT IF IT INCLUDES CERTAIN BENEFITS; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. (1) Every person authorized to issue a hospital or medical expense policy, hospital or medical service contract, employee welfare benefit plan, health and accident insurance policy, or any other insurance contract of this type in this state, including a group insurance plan, self-insurance plan, and the Mississippi State and School Employees Health Insurance Plan, delivered or issued for delivery in this state on or after January 1, 2001, shall offer to the policy holder in all group, blanket, and franchise policies an optional provision in the policy, contract, benefit plan, agreement, or program which states that benefits shall be payable for services rendered for the treatment of severe mental or nervous disorders, or both, illness under the same circumstances and conditions or greater as benefits are paid under those policies, contracts, benefits plans, agreements, or programs for all other diagnoses, illnesses, or accidents. For purposes of this section, "severe mental illness" shall include any of the following diagnosed severe mental illnesses:

(a) Schizophrenia or schizoaffective disorder;

(b) Bipolar disorder;

(c) Pervasive developmental disorder or autism;

(d) Panic disorder;

(e) Obsessive-compulsive disorder;

(f) Major depressive disorder;

(g) Anorexia/bulimia;

(h) Generalized anxiety disorder;

(i) Posttraumatic stress disorder;

(j) Psychosis NOS;

(k) Mental disorders due to a general medical condition;

(l) Tourette's Disorder.

(2) (a) Any issuer of a group, blanket, or franchise policy, contract, benefit plan, agreement, or program specified in subsection (1) shall also offer to the policyholder an optional provision in the policy, contract benefit plan, agreement, or program which states that benefits shall be payable for the treatment of mental disorders other than severe mental illness as defined in subsection (1) under the same circumstances and conditions as benefits are paid under those policies, contracts, benefit plans, agreements, or programs for all other diagnoses, illnesses, or accidents.

(b) If the policyholder elects not to purchase this optional coverage, the issuer shall notify the policyholder in any renewal, reinstatement, or modified policy, contract, benefit plan, agreement, or program as to the availability of the optional coverage.

(3) (a) The provisions of this section shall apply only to group, blanket, and franchise policies.

(b) The provisions of this section shall not apply to individually underwritten health insurance plans; short-term, limited-duration health insurance policies; and individually under written limited benefit and supplemental health insurance policies.

(4) A policy, contract, benefit plan, agreement, or program shall be in compliance with the requirements of subsection (1) if it includes the following benefits:

(a) Forty-five (45) inpatient days per covered individual per calendar year. However, a policy, contract, benefit plan, agreement, or program may provide a method to allow a covered individual to exchange two (2) days of partial hospitalization or two (2) days of residential treatment center hospitalization for each inpatient day of treatment.

(b) Fifty-two (52) outpatient visits per covered individual per calendar year, including the intensive outpatient program. However, a policy, contract, benefit plan, agreement, or program may provide a method to allow a covered individual to exchange one(1) inpatient day of treatment for four (4) outpatient visits or exchange four (4) outpatient visits for one (1) inpatient day of treatment.

(5) No policy, contract, benefit plan, agreement, or program issued or entered into pursuant to this section shall contain any provision for a waiting period in excess of sixty (60) days from the effective date of the policy before the benefits are payable for the treatment of severe mental illness or other mental disorders.

Nothing in this section shall be construed to prohibit management of the provision of benefits for mental disorders through such method as preadmission screening prior to the authorization of services or any other mechanism designed to limit coverage for services for mental disorders only to those deemed medically necessary by a licensed mental health professional.

SECTION 2. This act shall take effect and be in force from and after July 1, 2001.