Text: H05186 Text: H05188 Text: H05100 - H05199 Text: H Index Bills and Amendments: General Index Bill History: General Index
Get Version To Print
This file contains UNDERSCORE. If you cannot see the UNDERSCORE attribute or would like to change how this attribute is displayed, please use the following form to make the desired change.
-->
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 acupuncturist registered under chapter 148E. Access
1 15 to a specialist may be conditioned upon a referral by
1 16 a primary care provider licensed under chapter 148,
1 17 150A, or 151, or a primary care provider who is an
1 18 acupuncturist registered under chapter 148E. If a
1 19 primary care provider determines that a referral
1 20 should be made to a provider licensed, registered, or
1 21 otherwise regulated under another chapter, a managed
1 22 care health plan or indemnity plan with a limited
1 23 provider network may require that the referral be made
1 24 first to a provider designated by the plan. Any
1 25 copayment deductible, cost containment mechanism, or
1 26 premium rate shall not discriminate directly or
1 27 indirectly upon the basis of the license held by the
1 28 provider. Access to a specialist may be subject to a
1 29 different copayment or deductible than access to a
1 30 primary care provider. Access to a nonparticipating
1 31 provider may be restricted or may be subject to
1 32 different copayments, deductibles, or premium rates,
1 33 or may be excluded, provided that a plan shall not
1 34 differentiate or exclude a provider directly or
1 35 indirectly upon the basis of the license held by the
1 36 provider.
1 37 For purposes of this section, "managed care health
1 38 plan or indemnity plan with a limited provider
1 39 network" means a health maintenance organization,
1 40 organized delivery system, accountable health plan,
1 41 health care insurance plan which limits the number of
1 42 health care providers who can provide services under
1 43 the plan, preferred provider organization, exclusive
1 44 provider organization, restricted access network, or
1 45 similar health-care plan.""
1 46 #2. Title page, line 3, by striking the word
1 47 "physicians" and inserting the following:
1 48 "providers".
1 49
1 50
2 1
2 2 BRUNKHORST of Bremer
2 3 HF 2298.215 76
2 4 mj/jj
Text: H05186 Text: H05188 Text: H05100 - H05199 Text: H Index Bills and Amendments: General Index Bill History: General Index
Iowa General Assembly
Search: House Bills and Amendments (76th General Assembly)
© 1996 Cornell College and League of Women Voters of Iowa
Comments? webmaster@legis.iowa.gov.
Last update: Wed Mar 6 03:20:06 CST 1996
URL: /DOCS/GA/76GA/Legislation/H/05100/H05187/960305.html
jhf