Text: H05189 Text: H05191 Text: H05100 - H05199 Text: H Index Bills and Amendments: General Index Bill History: General Index
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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 hearing aid dealer licensed under
1 14 chapter 154A. Access to a specialist may be
1 15 conditioned upon a referral by a primary care provider
1 16 licensed under chapter 148, 150A, or 151, or a primary
1 17 care provider who is a hearing aid dealer licensed
1 18 under chapter 154A. If a primary care provider
1 19 determines that a referral should be made to a
1 20 provider licensed, registered, or otherwise regulated
1 21 under another chapter, a managed care health plan or
1 22 indemnity plan with a limited provider network may
1 23 require that the referral be made first to a provider
1 24 designated by the plan. Any copayment deductible,
1 25 cost containment mechanism, or premium rate shall not
1 26 discriminate directly or indirectly upon the basis of
1 27 the license held by the provider. Access to a
1 28 specialist may be subject to a different copayment or
1 29 deductible than access to a primary care provider.
1 30 Access to a nonparticipating provider may be
1 31 restricted or may be subject to different copayments,
1 32 deductibles, or premium rates, or may be excluded,
1 33 provided that a plan shall not differentiate or
1 34 exclude a provider directly or indirectly upon the
1 35 basis of the license held by the provider.
1 36 For purposes of this section, "managed care health
1 37 plan or indemnity plan with a limited provider
1 38 network" means a health maintenance organization,
1 39 organized delivery system, accountable health plan,
1 40 health care insurance plan which limits the number of
1 41 health care providers who can provide services under
1 42 the plan, preferred provider organization, exclusive
1 43 provider organization, restricted access network, or
1 44 similar health-care plan.""
1 45 #2. Title page, line 3, by striking the word
1 46 "physicians" and inserting the following:
1 47 "providers".
1 48
1 49
1 50
2 1 BRUNKHORST of Bremer
2 2 HF 2298.217 76
2 3 mj/jj
Text: H05189 Text: H05191 Text: H05100 - H05199 Text: H Index Bills and Amendments: General Index Bill History: General Index
Iowa General Assembly
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