Text: H05191 Text: H05193 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 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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