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PAG LIN
1 1 Section 1. NEW SECTION. 514C.11 ACCESS TO FACILITIES BY
1 2 PROVIDERS UNDER MANAGED CARE HEALTH PLANS OR INDEMNITY PLANS.
1 3 1. Notwithstanding section 514C.6, a managed care health
1 4 plan or indemnity plan with a limited provider network shall
1 5 accept both of the following as providers or locations for
1 6 provision of services:
1 7 a. A provider licensed under Title IV, subtitle 3, who
1 8 agrees to the conditions of the provider contract required by
1 9 the managed care health plan or indemnity plan notwithstanding
1 10 that the provider maintains medical staff privileges in a
1 11 rural hospital if the point of delivery of services is located
1 12 in a rural county.
1 13 b. A rural hospital if the hospital agrees to the
1 14 conditions of the provider contract and the fees established
1 15 under the contract for specific services as required by the
1 16 managed care health plan or indemnity plan.
1 17 2. For the purposes of this section:
1 18 a. "Managed care health plan or indemnity plan with a
1 19 limited provider network" means a health maintenance
1 20 organization, organized delivery system, exclusive provider
1 21 organization, point of service plan, standard indemnity
1 22 insurance plan, or any similar plan providing for health care
1 23 services.
1 24 b. "Rural county" means a county with a population of
1 25 thirty-five thousand or less.
1 26 c. "Rural hospital" means a licensed hospital which is
1 27 located in a rural county and which is the only hospital
1 28 licensed in that county.
1 29 EXPLANATION
1 30 This bill requires a managed care health plan or indemnity
1 31 plan with a limited provider network to accept as health care
1 32 providers those providers who are licensed under Title IV,
1 33 subtitle 3, of the Iowa Code, if the point of delivery of
1 34 services is located in a rural county and if the provider
1 35 accepts the conditions of the provider contract required by
2 1 the managed care health plan or indemnity plan,
2 2 notwithstanding that the provider maintains active medical
2 3 staff privileges in a rural hospital. The bill also requires
2 4 that a managed care health plan or indemnity plan with a
2 5 limited provider network accept, as a location for the
2 6 provision of services, a rural hospital if the hospital agrees
2 7 to the conditions of the provider contract and the fees
2 8 established under the contract for specific services as
2 9 required by the managed care health plan or indemnity plan.
2 10 The bill also provides a definition of "managed care health
2 11 plan or indemnity plan with a limited provider network", of
2 12 "rural county", and of "rural hospital".
2 13 LSB 3261SS 76
2 14 pf/jw/5.1
Text: SF02007 Text: SF02009 Text: SF02000 - SF02099 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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