Text: S03564 Text: S03566 Text: S03500 - S03599 Text: S Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend Senate File 484 as follows:
1 2 #1. Page 30, by inserting after line 32 the
1 3 following:
1 4 "Sec. . NEW SECTION. 514C.11 PATIENT ACCESS
1 5 TO TYPES OF PHYSICIANS UNDER MANAGED CARE HEALTH PLAN
1 6 OR INDEMNITY PLAN WITH LIMITED PROVIDER NETWORK.
1 7 Notwithstanding section 514C.6, a managed care
1 8 health plan or indemnity plan with a limited provider
1 9 network shall provide patients direct access to each
1 10 type of physician, as defined in section 135.1 and
1 11 licensed under chapter 148, 150A, or 151, and shall
1 12 not condition that access upon a referral by a
1 13 physician licensed under another chapter. Access to a
1 14 specialist may be conditioned upon a referral by a
1 15 primary care provider licensed under the same chapter.
1 16 Any copayment, deductible, cost containment mechanism,
1 17 or premium rate shall not discriminate directly or
1 18 indirectly upon the basis of the license held by the
1 19 physician. Access to a specialist may be subject to a
1 20 different copayment or deductible than access to a
1 21 primary care provider. Access to a nonparticipating
1 22 physician may be restricted or may be subject to
1 23 different copayments, deductibles, or premium rates,
1 24 or may be excluded, provided that a plan shall not
1 25 differentiate or exclude a physician directly or
1 26 indirectly upon the basis of the license held by the
1 27 physician.
1 28 Each plan must demonstrate that it is capable of
1 29 serving appropriately the needs of the subscriber
1 30 population in the service area of the plan with regard
1 31 to patient access to each type of physician.
1 32 For purposes of this section, "managed care health
1 33 plan or indemnity plan with a limited provider
1 34 network" means a health maintenance organization,
1 35 organized delivery system, accountable health plan,
1 36 health care insurance plan which limits the number of
1 37 licensed physicians who can provide services under the
1 38 plan, preferred provider organization, exclusive
1 39 provider organization, restricted access network, or
1 40 similar health-care plan. For purposes of this
1 41 section, "physician" means as defined in section 135.1
1 42 and licensed under chapter 148, 150A, or 151."
1 43 #2. By renumbering as necessary.
1 44
1 45
1 46
1 47 MICHAEL E. GRONSTAL
1 48 EUGENE S. FRAISE
1 49 EMIL J. HUSAK
1 50 JOHN W. JENSEN
2 1 BRAD BANKS
2 2 MARY A. LUNDBY
2 3 SF 484.201 76
2 4 mj/jj
Text: S03564 Text: S03566 Text: S03500 - S03599 Text: S Index Bills and Amendments: General Index Bill History: General Index
Iowa General Assembly
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