Text: SF00448 Text: SF00450 Text: SF00400 - SF00499 Text: SF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 514C.11 PATIENT ACCESS TO TYPES
1 2 OF PHYSICIANS UNDER MANAGED CARE HEALTH PLAN OR INDEMNITY PLAN
1 3 WITH LIMITED PROVIDER NETWORK.
1 4 Notwithstanding section 514C.6, a managed care health plan
1 5 or indemnity plan with a limited provider network shall
1 6 provide patients direct access to each type of physician, as
1 7 defined in section 135.1, and shall not condition that access
1 8 upon a referral by a physician licensed under another chapter.
1 9 Any copayment, deductible, cost containment mechanism, or
1 10 premium rate shall not discriminate directly or indirectly
1 11 upon the basis of the license held by the physician. Access
1 12 to a nonparticipating physician may be restricted or may be
1 13 subject to different copayments, deductibles, or premium
1 14 rates, or may be excluded, provided that a plan shall not
1 15 differentiate or exclude a physician directly or indirectly
1 16 upon the basis of the license held by the physician.
1 17 Each plan must demonstrate that it appropriately serves the
1 18 needs of the subscriber population in the service area of the
1 19 plan with regard to patient access to each type of physician.
1 20 For purposes of this section, "managed care health plan or
1 21 indemnity plan with a limited provider network" means a health
1 22 maintenance organization, organized delivery system,
1 23 accountable health plan, preferred provider organization,
1 24 exclusive provider organization, restricted access network, or
1 25 similar health-care plan. For purposes of this section,
1 26 "physician" means as defined in section 135.1.
1 27 EXPLANATION
1 28 This bill creates a new section 514C.11 which provides that
1 29 a managed care health plan or indemnity plan with a limited
1 30 provider network is to provide patients direct access to each
1 31 type of physician, as defined in section 135.1. The access
1 32 required pursuant to this section is not to be conditioned
1 33 upon a referral by a physician licensed under another chapter.
1 34 A copayment, deductible, cost containment mechanism, or
1 35 premium rate under such plan shall not discriminate directly
2 1 or indirectly upon the basis of the license held by a
2 2 physician. Access to a nonparticipating physician under such
2 3 plan may be restricted or may be subject to different copay-
2 4 ments, deductibles, or premium rates, or may be excluded under
2 5 the plan, so long as the differentiation or exclusion is not
2 6 upon the basis of the license held by the physician.
2 7 The bill requires that each plan demonstrate that it
2 8 appropriately serves the needs of the subscriber population in
2 9 the service area of the plan with regard to patient access to
2 10 physicians of each type.
2 11 LSB 2293SV 76
2 12 mj/jw/5
Text: SF00448 Text: SF00450 Text: SF00400 - SF00499 Text: SF Index Bills and Amendments: General Index Bill History: General Index
Iowa General Assembly
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