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House Amendment 5118

Amendment Text

PAG LIN
  1  1    Amend the amendment, H-5102, to House File 2298 as
  1  2 follows:
  1  3    #1.  Page 1, line 3, by striking the word "clause."
  1  4 and inserting the following:  "clause and inserting
  1  5 the following:"
  1  6    "Section 1.  NEW SECTION.  514C.11  PATIENT ACCESS
  1  7 TO TYPES OF PHYSICIANS UNDER MANAGED CARE HEALTH PLAN
  1  8 OR INDEMNITY PLAN WITH LIMITED PROVIDER NETWORK.
  1  9    Notwithstanding section 514C.6, a managed care
  1 10 health plan or indemnity plan with a limited provider
  1 11 network shall provide patients direct access to each
  1 12 type of physician, as defined in section 135.1 and
  1 13 licensed under chapter 148, 150A, or 151, and to each
  1 14 audiologist as defined in section 147.151, each person
  1 15 practicing osteopathy under chapter 150, each
  1 16 acupuncturist registered under chapter 148E, each
  1 17 occupational therapist licensed under chapter 148B,
  1 18 each podiatrist licensed under chapter 149, each
  1 19 registered or practical nurse licensed under chapter
  1 20 152, each dietician licensed under chapter 152A, each
  1 21 respiratory care practitioner licensed under chapter
  1 22 152B, each massage therapist licensed under chapter
  1 23 152C, each person engaged in the practice of optometry
  1 24 pursuant to chapter 154, each hearing aid dealer
  1 25 licensed under chapter 154A, each person engaged in
  1 26 the practice of psychology subject to regulation under
  1 27 chapter 154B, each person engaged in the practice of
  1 28 licensed social work subject to regulation under
  1 29 chapter 154C, each marital and family therapist
  1 30 licensed under chapter 154D, and each pharmacist
  1 31 licensed under chapter 155A.  Such direct access to a
  1 32 physician licensed under chapter 151 shall not be
  1 33 conditioned upon a referral by a provider licensed
  1 34 under another chapter.  Access to a specialist may be
  1 35 conditioned upon a referral by a primary care provider
  1 36 licensed under chapter 148, 150A, or 151, or a primary
  1 37 care provider who is an audiologist as defined in
  1 38 section 147.151, a person engaged in the practice of
  1 39 osteopathy under chapter 150, an acupuncturist
  1 40 registered under chapter 148E, an occupational
  1 41 therapist licensed under chapter 148B, a podiatrist
  1 42 licensed under chapter 149, a registered or practical
  1 43 nurse licensed under chapter 152, dietician licensed
  1 44 under chapter 152A, a respiratory care practitioner
  1 45 licensed under chapter 152B, a massage therapist
  1 46 licensed under chapter 152C, a person engaged in the
  1 47 practice of optometry pursuant to chapter 154, a
  1 48 hearing aid dealer licensed under chapter 154A, a
  1 49 person engaged in the practice of psychology and
  1 50 regulated under chapter 154B, a person engaged in the
  2  1 practice of licensed social work and regulated under
  2  2 chapter 154C, a marital and family therapist licensed
  2  3 under chapter 154D, a pharmacist licensed under
  2  4 chapter 155A.  If a primary care provider determines
  2  5 that a referral should be made to a provider licensed,
  2  6 registered, or otherwise regulated under another
  2  7 chapter, a managed care health plan or indemnity plan
  2  8 with a limited provider network may require that the
  2  9 referral be made first to a provider designated by the
  2 10 plan.  Any copayment deductible, cost containment
  2 11 mechanism, or premium rate shall not discriminate
  2 12 directly or indirectly upon the basis of the license
  2 13 held by the provider.  Access to a specialist may be
  2 14 subject to a different copayment or deductible than
  2 15 access to a primary care provider.  Access to a
  2 16 nonparticipating provider may be restricted or may be
  2 17 subject to different copayments, deductibles, or
  2 18 premium rates, or may be excluded, provided that a
  2 19 plan shall not differentiate or exclude a provider
  2 20 directly or indirectly upon the basis of the license
  2 21 held by the provider.
  2 22    Each plan must demonstrate that it is capable of
  2 23 serving appropriately the needs of the subscriber
  2 24 population in the service area of the plan with regard
  2 25 to patient access to each type of provider.  The
  2 26 commissioner of insurance shall adopt rules as
  2 27 necessary to administer this paragraph.
  2 28    For purposes of this section, "managed care health
  2 29 plan or indemnity plan with a limited provider
  2 30 network" means a health maintenance organization,
  2 31 organized delivery system, accountable health plan,
  2 32 health care insurance plan which limits the number of
  2 33 health care providers who can provide services under
  2 34 the plan, preferred provider organization, exclusive
  2 35 provider organization, restricted access network, or
  2 36 similar health-care plan.  For purposes of this
  2 37 section, "specialist" includes a physician who
  2 38 provides treatment for allergies, abdominal surgery,
  2 39 adolescent medicine, allergy and immunology, aerospace
  2 40 medicine, anesthesiology, broncho-esophagology,
  2 41 critical care medicine, cardiovascular diseases,
  2 42 cardiovascular surgery, child neurology, child
  2 43 psychiatry, clinical pathology, colon and rectal
  2 44 surgery, dermatology, diabetes, dermatopathology,
  2 45 diagnostic radiology, emergency medicine,
  2 46 endocrinology, forensic pathology, family practice,
  2 47 gastroenterology, geriatrics, general practice,
  2 48 general preventive medicine, general surgery,
  2 49 gynecology, hematology, head and neck surgery, hand
  2 50 surgery, hypnosis, infectious diseases, immunology,
  3  1 internal medicine, laryngology, maxillofacial surgery,
  3  2 neurology, neuropathology, neoplastic diseases,
  3  3 nephrology, nuclear medicine, neonatal-perinatal
  3  4 medicine, nuclear radiology, neurological surgery,
  3  5 nutrition, obstetrics and gynecology, obstetrics,
  3  6 occupational medicine, oncology, ophthalmology,
  3  7 orthopedic surgery, otology, otolaryngology,
  3  8 psychiatry, clinical pharmacology, pediatrics,
  3  9 pediatric allergy, pediatric cardiology, pediatric
  3 10 endocrinology, pediatric radiology, pediatric surgery,
  3 11 pediatric hematology-oncology, pediatric nephrology,
  3 12 physical medicine and rehabilitation, plastic surgery,
  3 13 facial plastic surgery, pathology, pulmonary diseases,
  3 14 psychoanalysis, psychosomatic medicine, radiology,
  3 15 rhinology, rheumatology, radioisotopic pathology,
  3 16 radiation oncology, therapeutic radiology, traumatic
  3 17 surgery, thoracic surgery, urological surgery,
  3 18 vascular surgery, or any other recognized physician
  3 19 specialty.""
  3 20    #2.  Title page, line 3, by striking the word
  3 21 "physicians" and inserting the following:
  3 22 "providers".  
  3 23 
  3 24 
  3 25                              
  3 26 DISNEY of Polk
  3 27 HF 2298.207 76
  3 28 mj/jj
     

Text: H05117                            Text: H05119
Text: H05100 - H05199                   Text: H Index
Bills and Amendments: General Index     Bill History: General Index

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