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
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