Text: H05464 Text: H05466 Text: H05400 - H05499 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 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 or 150A. Access to a
1 14 specialist may be conditioned upon a referral by a
1 15 primary care provider physician licensed under chapter
1 16 148 or 150A. Any copayment, deductible, cost
1 17 containment mechanism, or premium rate shall not
1 18 discriminate directly or indirectly upon the basis of
1 19 the license held by the physician. Access to a
1 20 specialist may be subject to a different copayment or
1 21 deductible than access to a primary care provider
1 22 physician. Access to a nonparticipating physician may
1 23 be restricted or may be subject to different
1 24 copayments, deductibles, or premium rates, or may be
1 25 excluded, provided that a plan shall not differentiate
1 26 or exclude a physician directly or indirectly upon the
1 27 basis of the license held by the physician.
1 28 For purposes of this section, "managed care health
1 29 plan or indemnity plan with a limited provider
1 30 network" means a health maintenance organization,
1 31 organized delivery system, accountable health plan,
1 32 health care insurance plan which limits the number of
1 33 health care providers who can provide services under
1 34 the plan, preferred provider organization, exclusive
1 35 provider organization, restricted access network, or
1 36 similar health-care plan. For purposes of this
1 37 section, "physician" means physician as defined in
1 38 section 135.1 and licensed under chapter 148 or 150A.
1 39 Sec. 2. Section 509.3, subsection 7, Code 1995, is
1 40 amended by striking the subsection.
1 41 Sec. 3. Section 514.7, unnumbered paragraph 4,
1 42 Code 1995, is amended by striking the paragraph.
1 43 Sec. 4. Section 514B.1, subsection 5, paragraph d,
1 44 Code 1995, is amended by striking the paragraph.""
1 45
1 46
1 47
1 48 METCALF of Polk
1 49 HF 2298.235 76
1 50 mj/jj
Text: H05464 Text: H05466 Text: H05400 - H05499 Text: H Index Bills and Amendments: General Index Bill History: General Index
Iowa General Assembly
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