House File 2299

                                       HOUSE FILE       
                                       BY  FORD


    Passed House, Date                Passed Senate,  Date             
    Vote:  Ayes        Nays           Vote:  Ayes        Nays         
                 Approved                            

                                      A BILL FOR

  1 An Act to require certain notices regarding the external review
  2    of denied health care insurance coverage.
  3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
  4 TLSB 6235HH 80
  5 kk/sh/8

PAG LIN

  1  1    Section 1.  Section 514J.2, Code 2003, is amended by adding
  1  2 the following new subsection:
  1  3    NEW SUBSECTION.  4A.  "Health care services" means services
  1  4 included in the furnishing to any individual of medical or
  1  5 dental care, or hospitalization, or incident to the furnishing
  1  6 of such care or hospitalization, as well as the furnishing to
  1  7 any person of all other services for the purposes of
  1  8 preventing, alleviating, curing, or healing human illness,
  1  9 injury, or physical disability.
  1 10    Sec. 2.  Section 514J.3A, Code 2003, is amended to read as
  1 11 follows:
  1 12    514J.3A  NOTICE.
  1 13    1.  When a claim is denied in whole or in part based on
  1 14 medical necessity, the carrier or organized delivery system
  1 15 shall provide a notice in writing to the enrollee of the
  1 16 internal appeal mechanism provided under the carrier or
  1 17 organized delivery system's plan or policy.
  1 18    2.  At the time of a coverage decision, the carrier or
  1 19 organized delivery system shall notify the enrollee in writing
  1 20 of the right to have the coverage decision reviewed under the
  1 21 external review process.
  1 22    3.  Every insurance identification card, including
  1 23 prescription drug information cards under chapter 514L, issued
  1 24 to an enrollee in this state shall contain a telephone number
  1 25 to request an external review for denied coverage pursuant to
  1 26 this chapter.  The notice shall be in a format approved by the
  1 27 commissioner.
  1 28    4.  In every hospital, clinic, health care facility, or
  1 29 place of business where health care services are provided in
  1 30 this state, there shall be posted in a conspicuous place for
  1 31 public view notice of an enrollee's right to seek external
  1 32 review of denied coverage pursuant to this chapter.  The
  1 33 notice shall be in a format approved by the commissioner.
  1 34                           EXPLANATION
  1 35    This bill requires certain notices to be given to enrollees
  2  1 regarding the right to an external review by the insurance
  2  2 commissioner of denied health insurance coverage.
  2  3    The bill requires that every insurance identification card,
  2  4 including prescription drug information cards, include a
  2  5 telephone number to request an external review of denied
  2  6 insurance coverage by the insurance commissioner.  The bill
  2  7 requires all hospitals, clinics, health care facilities, and
  2  8 any other place of business that provides health care services
  2  9 to post notices in the place of business for public view
  2 10 regarding the right to request an external review of denied
  2 11 insurance coverage by the insurance commissioner.  The bill
  2 12 defines "health care services".  The insurance commissioner
  2 13 shall approve the format of the notices.
  2 14 LSB 6235HH 80
  2 15 kk/sh/8