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
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