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Text: H05191                            Text: H05193
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House Amendment 5192

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 podiatrist licensed under chapter 149.  Access to a
  1 15 specialist may be conditioned upon a referral by a
  1 16 primary care provider licensed under chapter 148,
  1 17 150A, or 151, or a primary care provider who is a
  1 18 podiatrist licensed under chapter 149.  If a primary
  1 19 care provider determines that a referral should be
  1 20 made to a provider licensed, registered, or otherwise
  1 21 regulated under another chapter, a managed care health
  1 22 plan or indemnity plan with a limited provider network
  1 23 may require that the referral be made first to a
  1 24 provider designated by the plan.  Any copayment
  1 25 deductible, cost containment mechanism, or premium
  1 26 rate shall not discriminate directly or indirectly
  1 27 upon the basis of the license held by the provider.
  1 28 Access to a specialist may be subject to a different
  1 29 copayment or deductible than access to a primary care
  1 30 provider.  Access to a nonparticipating provider may
  1 31 be restricted or may be subject to different
  1 32 copayments, deductibles, or premium rates, or may be
  1 33 excluded, provided that a plan shall not differentiate
  1 34 or 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 2298.219 76
  2  3 mj/jj
     

Text: H05191                            Text: H05193
Text: H05100 - H05199                   Text: H Index
Bills and Amendments: General Index     Bill History: General Index

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