Text: H05184 Text: H05186 Text: H05100 - H05199 Text: H Index Bills and Amendments: General Index Bill History: General Index
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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 A managed care health plan or indemnity plan with a
1 10 limited provider network shall provide patients direct
1 11 access to each type of physician, as defined in
1 12 section 135.1 and licensed under chapter 148, 150A, or
1 13 151, and to each person engaged in the practice of
1 14 licensed social work subject to regulation under
1 15 chapter 154C. Access to a specialist may be
1 16 conditioned upon a referral by a primary care provider
1 17 licensed under chapter 148, 150A, or 151, or a primary
1 18 care provider who is a person engaged in the practice
1 19 of licensed social work and regulated under chapter
1 20 154C. If a primary care provider determines that a
1 21 referral should be made to a provider licensed,
1 22 registered, or otherwise regulated under another
1 23 chapter, a managed care health plan or indemnity plan
1 24 with a limited provider network may require that the
1 25 referral be made first to a provider designated by the
1 26 plan. Any copayment deductible, cost containment
1 27 mechanism, or premium rate shall not discriminate
1 28 directly or indirectly upon the basis of the license
1 29 held by the provider. Access to a specialist may be
1 30 subject to a different copayment or deductible than
1 31 access to a primary care provider. Access to a
1 32 nonparticipating provider may be restricted or may be
1 33 subject to different copayments, deductibles, or
1 34 premium rates, or may be excluded, provided that a
1 35 plan shall not differentiate or exclude a provider
1 36 directly or indirectly upon the basis of the license
1 37 held by the provider.
1 38 For purposes of this section, "managed care health
1 39 plan or indemnity plan with a limited provider
1 40 network" means a health maintenance organization,
1 41 organized delivery system, accountable health plan,
1 42 health care insurance plan which limits the number of
1 43 health care providers who can provide services under
1 44 the plan, preferred provider organization, exclusive
1 45 provider organization, restricted access network, or
1 46 similar health-care plan.""
1 47 #2. Title page, line 3, by striking the word
1 48 "physicians" and inserting the following:
1 49 "providers".
1 50
2 1
2 2
2 3 BRUNKHORST of Bremer
2 4 HF 2298.223 76
2 5 mj/jj
Text: H05184 Text: H05186 Text: H05100 - H05199 Text: H Index Bills and Amendments: General Index Bill History: General Index
Iowa General Assembly
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