Text: H05812 Text: H05814 Text: H05800 - H05899 Text: H Index Bills and Amendments: General Index Bill History: General Index
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PAG LIN
1 1 Amend House File 2298 as follows:
1 2 #1. By striking everything after the enacting
1 3 clause and inserting the following:
1 4 "Section 1. NEW SECTION. 514C.15 MANAGED CARE
1 5 HEALTH PLAN OR INDEMNITY PLAN WITH LIMITED PROVIDER
1 6 NETWORK – POINT-OF-SERVICE OPTION – DISPUTE
1 7 RESOLUTION – DISCLOSURE OF INFORMATION.
1 8 1. Notwithstanding section 514C.6, a managed care
1 9 health plan or indemnity plan with a limited provider
1 10 network shall provide a point-of-service option to
1 11 patients as an additional benefit under such plan.
1 12 Provision of a point-of-service option may be subject
1 13 to a different copayment or deductible, but such a
1 14 different copayment or deductible shall not be set at
1 15 an amount which is more than ten percent greater than
1 16 the amount of the copayment or deductible under the
1 17 plan without the point-of-service option, unless
1 18 otherwise approved by the commissioner of insurance.
1 19 2. A managed care health plan or indemnity plan
1 20 with a limited provider network shall not require
1 21 consent to the disclosure of information, other than
1 22 patient name, diagnosis, and date and type of service,
1 23 as a condition of receiving benefits mandated by such
1 24 plan.
1 25 3. A managed care health plan or indemnity plan
1 26 with a limited provider network shall not refuse to
1 27 contract with or compensate for covered services an
1 28 otherwise eligible provider or nonparticipating
1 29 provider solely because that provider has in good
1 30 faith communicated with one or more of such provider's
1 31 current, former, or prospective patients regarding the
1 32 provisions, terms, or requirements of such plan as
1 33 they relate to the needs of the patient.
1 34 4. A managed care health plan or indemnity plan
1 35 with a limited provider network shall establish a
1 36 dispute resolution process to resolve any complaint
1 37 involving a dispute about an immediate and urgently
1 38 needed service that such plan determines to be
1 39 experimental, not medically necessary, or otherwise
1 40 not generally accepted by the medical profession. A
1 41 complaint filed under this subsection need not be in
1 42 writing. Such plan shall establish an expedited
1 43 dispute resolution process appropriate to the
1 44 particular situation in dispute. Such process shall
1 45 provide for the following:
1 46 a. Notification of the commissioner of insurance
1 47 by the end of the next business day after the day the
1 48 complaint is filed with the plan including the nature
1 49 of the complaint, the decision of the plan, if any,
1 50 and a description of the dispute resolution process
2 1 used or being used, as appropriate.
2 2 b. If a decision has not been made by the end of
2 3 the next business day after the day the complaint is
2 4 filed, the plan shall notify the commissioner of
2 5 insurance of the decision of the plan by the end of
2 6 the next business day after the day the plan makes its
2 7 decision.
2 8 5. For purposes of this section, unless the
2 9 context otherwise requires:
2 10 a. "Managed care health plan or indemnity plan
2 11 with a limited provider network" means a health
2 12 maintenance organization, organized delivery system,
2 13 accountable health plan, health care insurance plan
2 14 which limits the number of licensed physicians who can
2 15 provide services under the plan, preferred provider
2 16 organization, exclusive provider organization,
2 17 restricted access network, or similar health-care
2 18 plan.
2 19 b. "Point-of-service option" means a delivery
2 20 system that permits a patient to receive services
2 21 outside the provider panel of the managed care health
2 22 plan or indemnity plan with a limited provider network
2 23 under the terms and conditions of such plan.
2 24 c. "Provider panel" means those providers with
2 25 which a managed care health plan or indemnity plan
2 26 with a limited provider network contracts to provide
2 27 services to covered individuals under such plan."
2 28
2 29
2 30
2 31 JOCHUM of Dubuque
2 32 HF 2298.715 76
2 33 mj/sc
Text: H05812 Text: H05814 Text: H05800 - H05899 Text: H Index Bills and Amendments: General Index Bill History: General Index
Iowa General Assembly
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