Text: H05803 Text: H05805 Text: H05800 - H05899 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. Such direct
1 14 access to a physician licensed under chapter 151 shall
1 15 not be conditioned upon a referral by a provider
1 16 licensed under another chapter. Access to a
1 17 specialist may be conditioned upon a referral by a
1 18 primary care provider physician licensed under chapter
1 19 148, 150A, or 151. If a physician licensed under
1 20 chapter 151 determines that a referral should be made
1 21 to a physician licensed under another chapter, a
1 22 managed care health plan or indemnity plan with a
1 23 limited provider network may require that the referral
1 24 be made first to a provider designated by the plan.
1 25 Any copayment deductible, cost containment mechanism,
1 26 or premium rate shall not discriminate directly or
1 27 indirectly upon the basis of the license held by the
1 28 physician. Access to a specialist may be subject to a
1 29 different copayment or deductible than access to a
1 30 primary care provider. Access to a nonparticipating
1 31 physician may be restricted or may be subject to
1 32 different copayments, deductibles, or premium rates,
1 33 or may be excluded, provided that a plan shall not
1 34 differentiate or exclude a physician directly or
1 35 indirectly upon the basis of the license held by the
1 36 physician.
1 37 Each plan must demonstrate that it is capable of
1 38 serving appropriately the needs of the subscriber
1 39 population in the service area of the plan with regard
1 40 to patient access to each type of physician. The
1 41 commissioner of insurance shall adopt rules as
1 42 necessary to administer this paragraph.
1 43 Each plan shall disclose to each individual
1 44 considering becoming a subscriber under such plan, at
1 45 a minimum, information related to all of the
1 46 following:
1 47 1. The number, type, and distribution of
1 48 participating providers, including a list of
1 49 individual participating providers, if requested.
1 50 2. Any limitations on the choice of health care
2 1 providers under the plan.
2 2 3. Coverage benefits under the plan, as well as
2 3 exclusions from coverage.
2 4 4. Prior authorization or other review
2 5 requirements and their potential impact on payment or
2 6 nonpayment for services.
2 7 5. Financial obligations of a subscriber under the
2 8 plan.
2 9 6. Subscriber rights and responsibilities.
2 10 7. The existence of any limited utilization
2 11 incentive plans which may reduce or limit services
2 12 covered under the plan.
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, or
2 24 151.""
2 25
2 26
2 27
2 28 GRUNDBERG of Polk
2 29 HF 2298.256 76
2 30 mj/jj
Text: H05803 Text: H05805 Text: H05800 - H05899 Text: H Index Bills and Amendments: General Index Bill History: General Index
Iowa General Assembly
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