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House Amendment 5773

Amendment Text

PAG LIN
  1  1    Amend the amendment, H-5102, to House File 2298 as
  1  2 follows:
  1  3    #1.  Page 1, by striking lines 2 and 3 and
  1  4 inserting the following:
  1  5    "#   .  Page 1, by inserting before line 1 the
  1  6 following:
  1  7    "Sec.    .  Section 135.1, subsection 4, Code
  1  8 Supplement 1995, is amended to read as follows:
  1  9    4.  "Physician" means a person licensed to practice
  1 10 medicine and surgery, osteopathic medicine and
  1 11 surgery, osteopathy, chiropractic, or podiatry, or
  1 12 optometry under the laws of this state; but a person
  1 13 licensed as a physician and surgeon shall be
  1 14 designated as a "physician" or "surgeon", a person
  1 15 licensed as an osteopathic physician and surgeon shall
  1 16 be designated as an "osteopathic physician" or
  1 17 "osteopathic surgeon", a person licensed as an
  1 18 osteopath shall be designated as an "osteopathic
  1 19 physician", a person licensed as a chiropractor shall
  1 20 be designated as a "chiropractor", and a person
  1 21 licensed as a podiatrist shall be designated as a
  1 22 "podiatric physician", and a person licensed as an
  1 23 optometrist shall be designated as an "optometrist"."
  1 24    #   .  By striking page 1, line 1, through page 2,
  1 25 line 7, and inserting the following:
  1 26    "Sec.    .  NEW SECTION.  514C.11  PATIENT ACCESS
  1 27 TO TYPES OF PHYSICIANS UNDER MANAGED CARE HEALTH PLAN
  1 28 OR INDEMNITY PLAN WITH LIMITED PROVIDER NETWORK.
  1 29    Notwithstanding section 514C.6, a managed care
  1 30 health plan or indemnity plan with a limited provider
  1 31 network shall provide patients direct access to each
  1 32 type of physician, as defined in section 135.1 and
  1 33 licensed under chapter 148, 150A, 151, or 154.  Such
  1 34 direct access to a physician licensed under chapter
  1 35 151 or 154 shall not be conditioned upon a referral by
  1 36 a provider licensed under another chapter.  Access to
  1 37 a specialist may be conditioned upon a referral by a
  1 38 primary care provider physician licensed under chapter
  1 39 148, 150A, 151, or 154.  If a physician licensed under
  1 40 chapter 151 or 154 determines that a referral should
  1 41 be made to a physician licensed under another chapter,
  1 42 a managed care health plan or indemnity plan with a
  1 43 limited provider network may require that the referral
  1 44 be made first to a provider designated by the plan.
  1 45 Any copayment deductible, cost containment mechanism,
  1 46 or premium rate shall not discriminate directly or
  1 47 indirectly upon the basis of the license held by the
  1 48 physician.  Access to a specialist may be subject to a
  1 49 different copayment or deductible than access to a
  1 50 primary care provider.  Access to a nonparticipating
  2  1 physician may be restricted or may be subject to
  2  2 different copayments, deductibles, or premium rates,
  2  3 or may be excluded, provided that a plan shall not
  2  4 differentiate or exclude a physician directly or
  2  5 indirectly upon the basis of the license held by the
  2  6 physician.
  2  7    Each plan must demonstrate that it is capable of
  2  8 serving appropriately the needs of the subscriber
  2  9 population in the service area of the plan with regard
  2 10 to patient access to each type of physician.  The
  2 11 commissioner of insurance shall adopt rules as
  2 12 necessary to administer this paragraph.
  2 13    For purposes of this section, "managed care health
  2 14 plan or indemnity plan with a limited provider
  2 15 network" means a health maintenance organization,
  2 16 organized delivery system, accountable health plan,
  2 17 health care insurance plan which limits the number of
  2 18 licensed physicians who can provide services under the
  2 19 plan, preferred provider organization, exclusive
  2 20 provider organization, restricted access network, or
  2 21 similar health-care plan.  For purposes of this
  2 22 section, "physician" means physician as defined in
  2 23 section 135.1 and licensed under chapter 148, 150A,
  2 24 151, or 154.""
  2 25    #2.  By renumbering as necessary.  
  2 26 
  2 27 
  2 28                              
  2 29 JACOBS of Polk
  2 30 HF 2298.317 76
  2 31 mj/cf
     
Text: H05772                            Text: H05774
Text: H05700 - H05799                   Text: H Index
Bills and Amendments: General Index     Bill History: General Index
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