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Bills and Amendments: General Index     Bill History: General Index

Senate Study Bill 21

Conference Committee Text

PAG LIN
  1  1    Section 1.  Section 68B.2A, subsection 1, paragraph a, Code
  1  2 1995, is amended to read as follows:
  1  3    a.  The outside employment or activity involves the use of
  1  4 the state's or the political subdivision's time, facilities,
  1  5 equipment, and supplies or the use of the state or political
  1  6 subdivision badge, uniform, business card, or other evidences
  1  7 of office or employment to give the person or member of the
  1  8 person's immediate family an advantage or pecuniary benefit
  1  9 that is not available to other similarly situated members or
  1 10 classes of members of the general public.  This paragraph does
  1 11 not apply to off-duty peace officers who provide private duty
  1 12 security or fire fighters or basic or advanced emergency
  1 13 medical care providers certified under chapter 147 or 147A who
  1 14 provide private duty fire safety or emergency medical services
  1 15 while carrying their badge or wearing their official uniform,
  1 16 provided that the person has secured the prior approval of the
  1 17 agency or political subdivision in which the person is
  1 18 regularly employed to engage in the activity.  For purposes of
  1 19 this subsection, a person is not "similarly situated" merely
  1 20 by being or being related to a person who serves or is
  1 21 employed by the state or a political subdivision of the state.
  1 22    Sec. 2.  Section 85.36, subsection 10, paragraph a, Code
  1 23 1995, is amended to read as follows:
  1 24    a.  In computing the compensation to be allowed a volunteer
  1 25 fire fighter, basic or advanced emergency medical care
  1 26 provider, or reserve peace officer, the earnings as a fire
  1 27 fighter, basic or advanced emergency medical care provider, or
  1 28 reserve peace officer shall be disregarded and the volunteer
  1 29 fire fighter, basic or advanced emergency medical care
  1 30 provider, or reserve peace officer shall be paid an amount
  1 31 equal to the compensation the volunteer fire fighter, basic or
  1 32 advanced emergency medical care provider, or reserve peace
  1 33 officer would be paid if injured in the normal course of the
  1 34 volunteer fire fighter's, basic or advanced emergency medical
  1 35 care provider's, or reserve peace officer's regular employment
  2  1 or an amount equal to one hundred and forty percent of the
  2  2 statewide average weekly wage, whichever is greater.
  2  3    Sec. 3.  Section 85.61, subsection 2, Code 1995, is amended
  2  4 to read as follows:
  2  5    2.  "Employer" includes and applies to a person, firm,
  2  6 association, or corporation, state, county, municipal
  2  7 corporation, school corporation, area education agency,
  2  8 township as an employer of volunteer fire fighters and basic
  2  9 or advanced emergency medical care providers only, benefited
  2 10 fire district, and the legal representatives of a deceased
  2 11 employer.  "Employer" includes and applies to a rehabilitation
  2 12 facility approved for purchase-of-service contracts or for
  2 13 referrals by the department of human services or the
  2 14 department of education.
  2 15    Sec. 4.  Section 85.61, subsection 7, unnumbered paragraph
  2 16 3, Code 1995, is amended to read as follows:
  2 17    Personal injuries sustained by basic emergency medical care
  2 18 providers, as defined in section 147.1, or by advanced
  2 19 emergency medical care providers as defined in section 147A.1,
  2 20 arise in the course of employment if the injuries are
  2 21 sustained at any time from the time the emergency medical care
  2 22 providers are summoned to duty until the time those duties
  2 23 have been fully discharged.
  2 24    Sec. 5.  Section 85.61, subsection 11, unnumbered paragraph
  2 25 3, Code 1995, is amended to read as follows:
  2 26    "Worker" or "employee" includes a basic an emergency
  2 27 medical care provider as defined in section 147.1, an advanced
  2 28 emergency medical care provider as defined in section 147A.1,
  2 29 a volunteer ambulance driver, or an emergency medical
  2 30 technician trainee, only if an agreement is reached between
  2 31 such worker or employee and the employer for whom the
  2 32 volunteer services are provided that workers' compensation
  2 33 coverage under chapters 85, 85A, and 85B is to be provided by
  2 34 the employer.  A basic or advanced An emergency medical care
  2 35 provider who is a worker or employee under this paragraph is
  3  1 not a casual employee.  "Volunteer ambulance driver" means a
  3  2 person performing services as a volunteer ambulance driver at
  3  3 the request of the person in charge of a fire department or
  3  4 ambulance service of a municipality.  "Emergency medical
  3  5 technician trainee" means a person enrolled in and training
  3  6 for emergency medical technician certification.
  3  7    Sec. 6.  Section 135.104, subsection 3, Code 1995, is
  3  8 amended to read as follows:
  3  9    3.  A screening program for children, with emphasis on
  3 10 children less than five six years of age.
  3 11    Sec. 7.  Section 135.105, Code 1995, is amended by adding
  3 12 the following new subsection:
  3 13    NEW SUBSECTION.  3.  Develop rules by January 1, 1996, and
  3 14 adopt rules by July 1, 1996, to provide for lead hazard
  3 15 inspections and the required mitigation of lead hazards in the
  3 16 case of a lead-poisoned child.  The department shall consult
  3 17 with federal, state, and local governments and agencies in
  3 18 developing the rules.  The rules shall be consistent with the
  3 19 recommendations of the centers for disease control and
  3 20 prevention of the United States department of health and human
  3 21 services.
  3 22    Sec. 8.  NEW SECTION.  135.105A  LEAD INSPECTOR AND LEAD
  3 23 ABATER TRAINING AND CERTIFICATION ESTABLISHED.
  3 24    The department shall establish a program for the training
  3 25 and certification of lead inspectors and lead abaters.  The
  3 26 department shall consult with federal, state, and local
  3 27 governments and agencies in developing the training and
  3 28 certification program.  The department shall maintain a
  3 29 listing, available to the public and to local health
  3 30 departments, of lead inspectors and lead abaters who have
  3 31 successfully completed the training program and have been
  3 32 certified by the department.  The department shall develop
  3 33 rules by January 1, 1996, and adopt rules by July 1, 1996,
  3 34 regarding training, certification, suspension, and revocation
  3 35 requirements and shall establish fees in amounts sufficient to
  4  1 defray the costs of the training and certification program.
  4  2 The rules shall also prohibit a certified lead inspector from
  4  3 also obtaining certification as a lead abater.  The programs
  4  4 shall be implemented no earlier than July 1, 1996.
  4  5    Sec. 9.  NEW SECTION.  135.105B  DEVELOPMENT OF STANDARDS
  4  6 FOR LEAD INSPECTION AND ABATEMENT.
  4  7    1.  The department shall develop standards by January 1,
  4  8 1996, and adopt standards by July 1, 1996, regarding
  4  9 inspection for lead-based paint and lead hazards and for
  4 10 abatement of lead hazards, including lead-based paint and lead
  4 11 hazards found in privately owned homes and rental property.
  4 12 The standards shall include but are not limited to definitions
  4 13 of "interim controls", "lead abatement", "lead hazard", "lead
  4 14 inspection", "lead-based paint", and "lead-poisoned child".
  4 15 The department shall consult with federal, state, and local
  4 16 governments and agencies in developing the standards.
  4 17    2.  The methods developed for lead inspections and
  4 18 abatement shall include, but are not limited to, the
  4 19 following:
  4 20    a.  Performance of lead inspections that are sufficient to
  4 21 detect the presence of lead-based paint and lead hazards.  The
  4 22 methods shall provide for the use of laboratories, approved by
  4 23 the department, for any lead inspection which necessitates the
  4 24 use of a laboratory to detect the presence of lead in samples
  4 25 of substances from premises.
  4 26    b.  Techniques approved by the department to abate lead
  4 27 hazards, with consideration of reliability, effectiveness, and
  4 28 affordability.  The standards shall include provisions for the
  4 29 protection of personal health and safety, hazard awareness,
  4 30 proper cleanup procedures, and other measures necessary to
  4 31 protect residents and workers.
  4 32    c.  Procedures for follow-up inspections and recordkeeping
  4 33 to ensure that abatement is completed.
  4 34    Sec. 10.  NEW SECTION.  135.105C  REQUIREMENTS &endash;
  4 35 PROVISIONS &endash; PENALTY.
  5  1    1.  Beginning July 1, 1996, a person shall not do any of
  5  2 the following:
  5  3    a.  Train lead inspectors or lead abaters unless the person
  5  4 is trained and certified in accordance with the rules
  5  5 established for training and certification by the department
  5  6 and unless the training program has been approved by the
  5  7 department.
  5  8    b.  Perform lead abatement work for compensation unless the
  5  9 person is certified as a lead abater.  A person shall not
  5 10 perform lead inspections for compensation unless the person is
  5 11 certified as a lead inspector.  Certification is not required
  5 12 for persons who perform lead abatement work or lead
  5 13 inspections without compensation.
  5 14    2.  If federal funding is received, beginning January 1,
  5 15 1997, a person who violates this section is subject to a civil
  5 16 penalty not to exceed five thousand dollars for each offense.
  5 17    Sec. 11.  Section 139B.1, subsection 1, paragraph d, Code
  5 18 1995, is amended to read as follows:
  5 19    d.  "Emergency care provider" means a person who is trained
  5 20 and authorized by federal or state law to provide emergency
  5 21 medical assistance or treatment, for compensation or in a
  5 22 voluntary capacity, including but not limited to, all of the
  5 23 following:
  5 24    (1)  A basic emergency care provider as defined in section
  5 25 147.1.
  5 26    (2) (1)  An advanced emergency medical care provider as
  5 27 defined in section 147A.1.
  5 28    (3) (2)  A health care provider as defined in this section.
  5 29    (4) (3)  A fire fighter.
  5 30    (5) (4)  A peace officer.
  5 31    "Emergency care provider" also includes a person who
  5 32 renders direct emergency aid without compensation.
  5 33    Sec. 12.  Section 141.22A, subsection 1, paragraph a, Code
  5 34 1995, is amended to read as follows:
  5 35    a.  "Emergency care provider" means a person who is trained
  6  1 and authorized by federal or state law to provide emergency
  6  2 medical assistance or treatment, for compensation or in a
  6  3 voluntary capacity, including but not limited to all of the
  6  4 following:
  6  5    (1)  A basic emergency medical care provider as defined in
  6  6 section 147.1.
  6  7    (2) (1)  An advanced emergency medical care provider as
  6  8 defined in section 147A.1.
  6  9    (3) (2)  A health care provider as defined in this section.
  6 10    (4) (3)  A fire fighter.
  6 11    (5) (4) A peace officer.
  6 12    "Emergency care provider" also includes a person who
  6 13 renders emergency aid without compensation.
  6 14    Sec. 13.  Section 142B.6, unnumbered paragraph 3, Code
  6 15 1995, is amended by striking the paragraph.
  6 16    Sec. 14.  Section 147.1, Code 1995, is amended by striking
  6 17 subsections 1, 3, 4, and 6.
  6 18    Sec. 15.  Section 147A.1, Code 1995, is amended by striking
  6 19 the section and inserting in lieu thereof the following:
  6 20    147A.1  DEFINITIONS.
  6 21    As used in this chapter, unless the context otherwise
  6 22 requires:
  6 23    1.  "Board" means the board of medical examiners appointed
  6 24 pursuant to section 147.14, subsection 2.
  6 25    2.  "Department" means the Iowa department of public
  6 26 health.
  6 27    3.  "Director" means the director of the Iowa department of
  6 28 public health.
  6 29    4.  "Emergency medical care" means such medical procedures
  6 30 as:
  6 31    a.  Administration of intravenous solutions.
  6 32    b.  Intubation.
  6 33    c.  Performance of cardiac defibrillation and synchronized
  6 34 cardioversion.
  6 35    d.  Administration of emergency drugs as provided by rule
  7  1 by the department.
  7  2    e.  Any other medical procedure approved by the department,
  7  3 by rule, as appropriate to be performed by emergency medical
  7  4 care providers who have been trained in that procedure.
  7  5    5.  "Emergency medical care provider" means an individual
  7  6 trained to provide emergency and nonemergency medical care at
  7  7 the first-responder, EMT-basic, EMT-intermediate, EMT-
  7  8 paramedic level, or other certification levels adopted by rule
  7  9 by the department, who has been issued a certificate by the
  7 10 department.
  7 11    6.  "Emergency medical services" or "EMS" means an
  7 12 integrated medical care delivery system to provide emergency
  7 13 and nonemergency medical care at the scene or during out-of-
  7 14 hospital patient transportation in an ambulance.
  7 15    7.  "Emergency medical services instructor" means an
  7 16 individual who has successfully completed an EMS curriculum
  7 17 approved by the department and is currently certified by the
  7 18 department as an EMS instructor.
  7 19    8.  "Emergency rescue technician" or "EMT" means an
  7 20 individual trained in various rescue techniques including, but
  7 21 not limited to, extrication from vehicles and agricultural
  7 22 rescue, and who has successfully completed a curriculum
  7 23 approved by the department in cooperation with the Iowa fire
  7 24 service institute.
  7 25    9.  "First responder" or "FR" means an individual trained
  7 26 in patient-stabilizing techniques, through the use of initial
  7 27 basic emergency medical care procedures and skills prior to
  7 28 the arrival of an ambulance, pursuant to rules established by
  7 29 the department and who is currently certified as a first
  7 30 responder by the department.
  7 31    10.  "Physician" means an individual licensed under chapter
  7 32 148, 150, or 150A.
  7 33    Sec. 16.  NEW SECTION.  147A.2  COUNCIL ESTABLISHED &endash;
  7 34 TERMS OF OFFICE.
  7 35    An EMS advisory council shall be appointed by the director.
  8  1 Membership of the council shall be comprised of individuals
  8  2 nominated from, but not limited to, the following state or
  8  3 national organizations:  Iowa osteopathic medical association,
  8  4 Iowa medical society, American college of emergency
  8  5 physicians, university of Iowa hospitals and clinics, Iowa EMS
  8  6 association, Iowa firemen's association, EMS education
  8  7 programs committee, EMS regional council, Iowa nurses
  8  8 association, Iowa hospital association, and the Iowa state
  8  9 association of counties.
  8 10    The EMS advisory council shall advise the director and
  8 11 develop policy recommendations concerning the regulation,
  8 12 administration, and coordination of emergency medical services
  8 13 in the state.
  8 14    Sec. 17.  NEW SECTION.  147A.3  MEETINGS OF THE COUNCIL &endash;
  8 15 QUORUM &endash; EXPENSES.
  8 16    Membership, terms of office, quorum, and expenses shall be
  8 17 determined by the director pursuant to chapter 135.
  8 18    Sec. 18.  Section 147A.4, Code 1995, is amended to read as
  8 19 follows:
  8 20    147A.4  RULEMAKING AUTHORITY.
  8 21    1.  The department shall adopt rules required or authorized
  8 22 by this chapter pertaining to the operation of ambulance,
  8 23 rescue, and first response services which have received
  8 24 authorization under section 147A.5 to utilize the services of
  8 25 certified advanced emergency medical care providers.  These
  8 26 rules shall include, but need not be limited to, requirements
  8 27 concerning physician supervision, necessary equipment and
  8 28 staffing, and reporting by ambulance, rescue, and first
  8 29 response services which have received the authorization
  8 30 pursuant to section 147A.5.
  8 31    The director, pursuant to rule, may grant exceptions and
  8 32 variances from the requirements of rules adopted under this
  8 33 chapter for any ambulance, rescue, or first response service.
  8 34 Exceptions or variations shall be reasonably related to undue
  8 35 hardships which existing services experience in complying with
  9  1 this chapter or the rules adopted pursuant to this chapter.
  9  2 However, no exception or variance may be granted unless the
  9  3 service has adopted a plan approved by the department prior to
  9  4 January 1, 1996, to achieve compliance with this chapter and
  9  5 rules adopted pursuant to this chapter.  Services requesting
  9  6 exceptions and variances shall be subject to other applicable
  9  7 rules adopted pursuant to this chapter.
  9  8    2.  The department shall adopt rules required or authorized
  9  9 by this chapter pertaining to the examination and
  9 10 certification of advanced emergency medical care providers.
  9 11 These rules shall include, but need not be limited to,
  9 12 requirements concerning prerequisites, training, and
  9 13 experience for advanced emergency medical care providers and
  9 14 procedures for determining when individuals have met these
  9 15 requirements.  The department shall consult with the board
  9 16 concerning these rules.
  9 17    3.  The department shall establish the fee for the
  9 18 examination of the advanced emergency medical care providers
  9 19 to cover the administrative costs of the examination program.
  9 20    Sec. 19.  Section 147A.5, subsections 1 and 3, Code 1995,
  9 21 are amended to read as follows:
  9 22    1.  An ambulance, rescue, or first response service in this
  9 23 state, that desires to provide advanced emergency medical care
  9 24 in the prehospital out-of-hospital setting, shall apply to the
  9 25 department for authorization to establish a program utilizing
  9 26 certified advanced emergency medical care providers for
  9 27 delivery of the care at the scene of an emergency, during
  9 28 transportation to a hospital, during transfer from one medical
  9 29 care facility to another or to a private residence, or while
  9 30 in the hospital emergency department, and until care is
  9 31 directly assumed by a physician or by authorized hospital
  9 32 personnel.
  9 33    3.  The department may deny an application for
  9 34 authorization to establish a program utilizing the services of
  9 35 certified advanced emergency medical care providers, or may
 10  1 place on probation, suspend, or revoke existing authorization
 10  2 if the department finds reason to believe the program has not
 10  3 been or will not be operated in compliance with this chapter
 10  4 and the rules adopted pursuant to this chapter, or that there
 10  5 is insufficient assurance of adequate protection for the
 10  6 public.  The denial or period of probation, suspension, or
 10  7 revocation shall be effected and may be appealed as provided
 10  8 by section 17A.12.
 10  9    Sec. 20.  Section 147A.6, Code 1995, is amended to read as
 10 10 follows:
 10 11    147A.6  ADVANCED EMERGENCY MEDICAL CARE PROVIDER
 10 12 CERTIFICATES &endash; RENEWAL.
 10 13    1.  The department, upon application and receipt of the
 10 14 prescribed fee, shall issue a certificate attesting to the
 10 15 qualifications of to an individual who has met all of the
 10 16 requirements for advanced emergency medical care provider
 10 17 certification established by the rules adopted under section
 10 18 147A.4, subsection 2.
 10 19    2.  Advanced emergency Emergency medical care provider
 10 20 certificates are valid for the multiyear period determined by
 10 21 the department, unless sooner suspended or revoked.  The
 10 22 certificate shall be renewed upon application of the holder
 10 23 and receipt of the prescribed fee if the holder has
 10 24 satisfactorily completed continuing medical education programs
 10 25 as required by rule.
 10 26    Sec. 21.  Section 147A.7, subsection 1, unnumbered
 10 27 paragraph 1, Code 1995, is amended to read as follows:
 10 28    The board department may deny an application for issuance
 10 29 or renewal of an advanced emergency medical care provider
 10 30 certificate, or suspend or revoke the certificate when it
 10 31 finds that the applicant or certificate holder is guilty of
 10 32 any of the following acts or offenses:
 10 33    Sec. 22.  Section 147A.7, subsection 1, paragraphs j and k,
 10 34 Code 1995, are amended to read as follows:
 10 35    j.  Violating a statute of this state, another state, or
 11  1 the United States, without regard to its designation as either
 11  2 a felony or misdemeanor, which relates to the practice of an
 11  3 advanced emergency medical care provider.  A copy of the
 11  4 record of conviction or plea of guilty is conclusive evidence
 11  5 of the violation.
 11  6    k.  Having certification to practice as an advanced
 11  7 emergency medical care provider revoked or suspended, or
 11  8 having other disciplinary action taken by a licensing or
 11  9 certifying authority of another state, territory, or country.
 11 10 A certified copy of the record or order of suspension,
 11 11 revocation, or disciplinary action is conclusive or prima
 11 12 facie evidence.
 11 13    Sec. 23.  Section 147A.8, Code 1995, is amended to read as
 11 14 follows:
 11 15    147A.8  AUTHORITY OF CERTIFIED ADVANCED EMERGENCY MEDICAL
 11 16 CARE PROVIDER.
 11 17    An advanced emergency medical care provider properly
 11 18 certified under this chapter may:
 11 19    1.  Render advanced emergency and nonemergency medical
 11 20 care, rescue, and lifesaving services in those areas for which
 11 21 the advanced emergency medical care provider is certified, as
 11 22 defined and approved in accordance with the rules of the
 11 23 department, at the scene of an emergency, during
 11 24 transportation to a hospital or while in the hospital
 11 25 emergency department, and until care is directly assumed by a
 11 26 physician or by authorized hospital personnel.
 11 27    2.  Function in any hospital when:
 11 28    a.  Enrolled as a student or participating as a preceptor
 11 29 in a training program approved by the department; or
 11 30    b.  Fulfilling continuing education requirements as defined
 11 31 by rule; or
 11 32    c.  Employed by or assigned to a hospital as a member of an
 11 33 authorized ambulance, rescue, or first response service, by
 11 34 rendering lifesaving services in the facility in which
 11 35 employed or assigned pursuant to the advanced emergency
 12  1 medical care provider's certification and under the direct
 12  2 supervision of a physician, physician assistant, or registered
 12  3 nurse.  An advanced emergency medical care provider shall not
 12  4 routinely function without the direct supervision of a
 12  5 physician, physician assistant, or registered nurse.  However,
 12  6 when the physician, physician assistant, or registered nurse
 12  7 cannot directly assume emergency care of the patient, the
 12  8 advanced emergency medical care provider may perform without
 12  9 direct supervision advanced emergency medical care procedures
 12 10 for which that individual is certified if the life of the
 12 11 patient is in immediate danger and such care is required to
 12 12 preserve the patient's life; or
 12 13    d.  Employed by or assigned to a hospital as a member of an
 12 14 authorized ambulance, rescue, or first response service to
 12 15 perform nonlifesaving procedures for which those individuals
 12 16 have been trained and are designated in a written job
 12 17 description.  Such procedures may be performed after the
 12 18 patient is observed by and when the advanced emergency medical
 12 19 care provider is under the supervision of the physician,
 12 20 physician assistant, or registered nurse and where the
 12 21 procedure may be immediately abandoned without risk to the
 12 22 patient.
 12 23    The department shall consult with the board concerning
 12 24 rules and training requirements related to this section.
 12 25    Sec. 24.  Section 147A.9, Code 1995, is amended to read as
 12 26 follows:
 12 27    147A.9  REMOTE SUPERVISION OF ADVANCED EMERGENCY MEDICAL
 12 28 CARE PROVIDERS &endash; EMERGENCY COMMUNICATION FAILURE &endash;
 12 29 AUTHORIZATION OF IMMEDIATE LIFESAVING TO INITIATE EMERGENCY
 12 30 MEDICAL CARE PROCEDURES.
 12 31    1.  When voice contact or a telemetered electrocardiogram
 12 32 is monitored by a physician, physician's designee, or
 12 33 physician assistant, and direct communication is maintained,
 12 34 an advanced emergency medical care provider may upon order of
 12 35 the monitoring physician or upon standing orders of a
 13  1 physician transmitted by the monitoring physician's designee
 13  2 or physician assistant perform any advanced emergency medical
 13  3 care procedure for which that advanced emergency medical care
 13  4 provider is certified.
 13  5    2.  If communications fail during an emergency or
 13  6 nonemergency situation, the advanced emergency medical care
 13  7 provider may perform any advanced emergency medical care
 13  8 procedure for which that individual is certified and which is
 13  9 included in written protocols if in the judgment of the
 13 10 advanced emergency medical care provider the life of the
 13 11 patient is in immediate danger and such care is required to
 13 12 preserve the patient's life.
 13 13    3.  The department shall adopt rules to authorize the
 13 14 institution of lifesaving medical care procedures which can be
 13 15 initiated in accordance with written protocols in instances
 13 16 where prior to the establishment of communication in lieu of
 13 17 immediate action may cause patient harm or death.
 13 18    4.  The department shall consult with the board concerning
 13 19 rules related to this section.
 13 20    Sec. 25.  Section 147A.10, Code 1995, is amended to read as
 13 21 follows:
 13 22    147A.10  EXEMPTIONS FROM LIABILITY IN CERTAIN
 13 23 CIRCUMSTANCES.
 13 24    1.  A physician, physician's designee, or physician
 13 25 assistant, who gives orders, either directly or via
 13 26 communications equipment from some other point, or via
 13 27 standing protocols to an appropriately certified advanced
 13 28 emergency medical care provider or registered nurse at the
 13 29 scene of an emergency, and an appropriately certified advanced
 13 30 emergency medical care provider or registered nurse following
 13 31 the orders, are not subject to criminal liability by reason of
 13 32 having issued or executed the orders, and are not liable for
 13 33 civil damages for acts or omissions relating to the issuance
 13 34 or execution of the orders unless the acts or omissions
 13 35 constitute recklessness.
 14  1    2.  A physician, physician's designee, physician assistant,
 14  2 registered nurse, or advanced emergency medical care provider
 14  3 shall not be subject to civil liability solely by reason of
 14  4 failure to obtain consent before rendering emergency medical,
 14  5 surgical, hospital or health services to any individual,
 14  6 regardless of age, when the patient is unable to give consent
 14  7 for any reason and there is no other person reasonably
 14  8 available who is legally authorized to consent to the
 14  9 providing of such care.
 14 10    3.  An act of commission or omission of any appropriately
 14 11 certified advanced emergency medical care provider, registered
 14 12 nurse, or physician assistant while rendering advanced
 14 13 emergency medical care under the responsible supervision and
 14 14 control of a physician to a person who is deemed by them to be
 14 15 in immediate danger of serious injury or loss of life, shall
 14 16 not impose any liability upon the certified advanced emergency
 14 17 medical care provider, registered nurse, or physician
 14 18 assistant, the supervising physician, physician designee, or
 14 19 any hospital, or upon the state, or any county, city or other
 14 20 political subdivision, or the employees of any of these
 14 21 entities; provided that this section shall not relieve any
 14 22 person of liability for civil damages for any act of
 14 23 commission or omission which constitutes recklessness.
 14 24    Sec. 26.  Section 147A.11, subsections 1 and 2, Code 1995,
 14 25 are amended to read as follows:
 14 26    1.  Any person not certified as required by this chapter
 14 27 who claims to be an advanced emergency medical care provider,
 14 28 or who uses any other term to indicate or imply that the
 14 29 person is an advanced emergency medical care provider, or who
 14 30 acts as an advanced emergency medical care provider without
 14 31 having obtained the appropriate certificate under this
 14 32 chapter, is guilty of a class "D" felony.
 14 33    2.  An owner of an unauthorized ambulance, rescue, or first
 14 34 response service in this state who operates or purports to
 14 35 operate an authorized ambulance, rescue, or first response
 15  1 service, or who uses any term to indicate or imply such
 15  2 authorization without having obtained the appropriate
 15  3 authorization under this chapter, is guilty of a class "D"
 15  4 felony.
 15  5    Sec. 27.  Section 147A.12, subsection 1, Code 1995, is
 15  6 amended to read as follows:
 15  7    1.  This chapter does not restrict a registered nurse,
 15  8 licensed pursuant to chapter 152, from staffing an authorized
 15  9 ambulance, rescue, or first response service provided the
 15 10 registered nurse can document equivalency through education
 15 11 and additional skills training essential in the delivery of
 15 12 prehospital out-of-hospital emergency care.  The equivalency
 15 13 shall be accepted when:
 15 14    a.  Documentation has been reviewed and approved at the
 15 15 local level by the medical director of the ambulance, rescue,
 15 16 or first response service in accordance with the rules of the
 15 17 board of nursing developed jointly with the board of medical
 15 18 examiners department.
 15 19    b.  Authorization has been granted to that ambulance,
 15 20 rescue, or first response service by the department.
 15 21    Sec. 28.  Section 147A.13, Code 1995, is amended to read as
 15 22 follows:
 15 23    147A.13  PHYSICIAN ASSISTANT EXCEPTION.
 15 24    This chapter does not restrict a physician assistant,
 15 25 licensed pursuant to chapter 148C, from staffing an authorized
 15 26 ambulance, rescue, or first response service if the physician
 15 27 assistant can document equivalency through education and
 15 28 additional skills training essential in the delivery of
 15 29 prehospital out-of-hospital emergency care.  The equivalency
 15 30 shall be accepted when:
 15 31    1.  Documentation has been reviewed and approved at the
 15 32 local level by the medical director of the ambulance, rescue,
 15 33 or first response service in accordance with the rules of the
 15 34 board of physician assistant examiners developed jointly with
 15 35 the department.
 16  1    2.  Authorization has been granted to that ambulance,
 16  2 rescue, or first response service by the department.
 16  3    Sec. 29.  NEW SECTION.  147A.20  TITLE OF DIVISION.
 16  4    This division may be cited as the "Iowa Trauma Care System
 16  5 Development Act".
 16  6    Sec. 30.  NEW SECTION.  147A.21  DEFINITIONS.
 16  7    As used in this division, unless the context otherwise
 16  8 requires:
 16  9    1.  "Categorization" means a preliminary determination by
 16 10 the department that a hospital or emergency care facility is
 16 11 capable of providing trauma care in accordance with criteria
 16 12 adopted pursuant to chapter 17A for levels I, II, III, and IV
 16 13 care capabilities.
 16 14    2.  "Department" means the Iowa department of public
 16 15 health.
 16 16    3.  "Director" means the director of public health.
 16 17    4.  "Emergency care facility" means a physician's office,
 16 18 clinic, or other health care center which provides emergency
 16 19 medical care in conjunction with other primary care services.
 16 20    5.  "Hospital" means a facility licensed under chapter
 16 21 135B, or a comparable emergency care facility located and
 16 22 licensed in another state.
 16 23    6.  "Trauma" means a single or multisystem life-threatening
 16 24 or limb-threatening injury, or an injury requiring immediate
 16 25 medical or surgical intervention or treatment to prevent death
 16 26 or permanent disability.
 16 27    7.  "Trauma care facility" means a hospital or emergency
 16 28 care facility which provides trauma care and has been verified
 16 29 by the department as having level I, II, III, or IV care
 16 30 capabilities and issued a certificate of verification pursuant
 16 31 to section 147A.23, subsection 2, paragraph "c".
 16 32    8.  "Trauma care system" means an organized approach to
 16 33 providing personnel, facilities, and equipment for effective
 16 34 and coordinated trauma care.
 16 35    9.  "Verification" means a formal process by which the
 17  1 department certifies a hospital or emergency care facility's
 17  2 capacity to provide trauma care in accordance with criteria
 17  3 established for levels I, II, III, and IV trauma care
 17  4 facilities.
 17  5    Sec. 31.  NEW SECTION.  147A.22  LEGISLATIVE FINDINGS AND
 17  6 INTENT &endash; PURPOSE.
 17  7    The general assembly finds the following:
 17  8    1.  Trauma is a serious health problem in the state of Iowa
 17  9 and is the leading cause of death of younger Iowans.  The
 17 10 death and disability associated with traumatic injury
 17 11 contributes to the significant medical expenses and lost work,
 17 12 and adversely affects the productivity of Iowans.
 17 13    2.  Optimal trauma care is limited in many parts of the
 17 14 state.  With health care delivery in transition, access to
 17 15 quality trauma and emergency medical care continues to
 17 16 challenge our rural communities.
 17 17    3.  The goal of a statewide trauma care system is to
 17 18 coordinate the medical needs of the injured person with an
 17 19 integrated system of optimal and cost-effective trauma care.
 17 20 The result of a well-coordinated statewide trauma care system
 17 21 is to reduce the incidences of inadequate trauma care and
 17 22 preventable deaths, minimize human suffering, and decrease the
 17 23 costs associated with preventable mortality and morbidity.
 17 24    4.  The development of the Iowa trauma care system will
 17 25 achieve these goals while meeting the unique needs of the
 17 26 rural residents of the state.
 17 27    Sec. 32.  NEW SECTION.  147A.23  TRAUMA CARE SYSTEM
 17 28 DEVELOPMENT.
 17 29    1.  The department is designated as a lead agency in this
 17 30 state responsible for the development of a statewide trauma
 17 31 care system.
 17 32    2.  The department, in consultation with the trauma system
 17 33 advisory council, shall develop, coordinate, and monitor a
 17 34 statewide trauma care system.  This system shall include, but
 17 35 not be limited to, the following:
 18  1    a.  The categorization of all hospitals and emergency care
 18  2 facilities by the department as to their capacity to provide
 18  3 trauma care services.  The categorization shall be determined
 18  4 by the department from self-reported information provided to
 18  5 the department by the hospital or emergency care facility.
 18  6 This categorization shall not be construed to imply any
 18  7 guarantee on the part of the department as to the level of
 18  8 trauma care services available at the hospital or emergency
 18  9 care facility.
 18 10    b.  The issuance of a certificate of verification of all
 18 11 categorized hospitals and emergency care facilities from the
 18 12 department at the level preferred by the hospital or emergency
 18 13 care facility.  The standards and verification process shall
 18 14 be established by rule and may vary as appropriate by level of
 18 15 trauma care capability.  To the extent possible, the standards
 18 16 and verification process shall be coordinated with other
 18 17 applicable accreditation and licensing standards.
 18 18    c.  Upon verification and the issuance of a certificate of
 18 19 verification, a hospital or emergency care facility agrees to
 18 20 maintain a level of commitment and resources sufficient to
 18 21 meet responsibilities and standards as required by the trauma
 18 22 care criteria established by rule under this division.
 18 23 Verifications are valid for a period of three years or as
 18 24 determined by the department and are renewable.  As part of
 18 25 the verification and renewal process, the department may
 18 26 conduct periodic on-site reviews of the services and
 18 27 facilities of the hospital or emergency care facility.
 18 28    d.  The department may establish fees to help defray the
 18 29 costs of this division.  All fees generated shall be deposited
 18 30 in the emergency medical services fund established in section
 18 31 135.25.
 18 32    e.  This section shall not be construed to restrict the
 18 33 ability of a hospital or emergency care facility to provide
 18 34 services for which it has been duly authorized.
 18 35    f.  This section shall not be construed to limit the number
 19  1 and distribution of levels I, II, III, and IV categorized and
 19  2 verified trauma care facilities in a community or region.
 19  3    Sec. 33.  NEW SECTION.  147A.24  TRAUMA SYSTEM ADVISORY
 19  4 COUNCIL ESTABLISHED.
 19  5    1.  A trauma system advisory council is established.  The
 19  6 following organizations or officials may recommend a
 19  7 representative to the council:
 19  8    a.  American academy of pediatrics.
 19  9    b.  American college of emergency physicians, Iowa chapter.
 19 10    c.  American college of surgeons, Iowa chapter.
 19 11    d.  Department of public health.
 19 12    e.  Governor's traffic safety bureau.
 19 13    f.  Iowa emergency medical services association.
 19 14    g.  Iowa emergency nurses association.
 19 15    h.  Iowa hospital association representing rural hospitals.
 19 16    i.  Iowa hospital association representing urban hospitals.
 19 17    j.  Iowa medical society.
 19 18    k.  Iowa osteopathic medical society.
 19 19    l.  Rehabilitation services delivery representative.
 19 20    m.  State emergency medical services medical director.
 19 21    n.  State medical examiner.
 19 22    o.  Trauma nurse coordinator representing a trauma registry
 19 23 hospital.
 19 24    p.  University of Iowa, injury prevention research center.
 19 25    2.  The council shall be appointed by the director from the
 19 26 recommendations of the organizations in subsection 1 for terms
 19 27 of two years.  Vacancies on the council shall be filled for
 19 28 the remainder of the term of the original appointment.
 19 29 Members whose terms expire may be reappointed.
 19 30    3.  The voting members of the council shall elect a
 19 31 chairperson and a vice chairperson and other officers as the
 19 32 council deems necessary.  The officers shall serve until their
 19 33 successors are elected and qualified.
 19 34    4.  The council shall do all of the following:
 19 35    a.  Advise the department on issues and strategies to
 20  1 achieve optimal trauma care delivery throughout the state.
 20  2    b.  Assist the department in the implementation of an Iowa
 20  3 trauma care plan.
 20  4    c.  Develop criteria for the categorization of all
 20  5 hospitals and emergency care facilities according to their
 20  6 trauma care capabilities.  These categories shall be for
 20  7 levels I, II, III, and IV, based on the most current
 20  8 guidelines published by the American college of surgeons
 20  9 committee on trauma, the American college of emergency
 20 10 physicians, and the model trauma care plan of the United
 20 11 States department of health and human services' health
 20 12 resources and services administration.
 20 13    d.  Develop a process for the verification of the trauma
 20 14 care capacity of each facility and the issuance of a
 20 15 certificate of verification.
 20 16    e.  Develop standards for medical direction, trauma care,
 20 17 triage and transfer protocols, and trauma registries.
 20 18    f.  Promote public information and education activities for
 20 19 injury prevention.
 20 20    g.  Review the rules adopted under this division and make
 20 21 recommendations to the director for changes to further promote
 20 22 optimal trauma care.
 20 23    Sec. 34.  NEW SECTION.  147A.25  SYSTEM EVALUATION AND
 20 24 QUALITY IMPROVEMENT COMMITTEE.
 20 25    1.  The department shall create a system evaluation and
 20 26 quality improvement committee to develop, implement, and
 20 27 conduct trauma care system evaluation, quality assessment, and
 20 28 quality improvement.  The director shall appoint the members
 20 29 of the committee which shall include the following:
 20 30    a.  Two trauma surgeons.
 20 31    b.  One neurologic surgeon and one orthopedic surgeon.
 20 32    c.  Two emergency physicians.
 20 33    d.  Two trauma nurse coordinators.
 20 34    e.  Two emergency nurses.
 20 35    f.  Two out-of-hospital emergency medical care providers.
 21  1    g.  Department of public health trauma coordinator.
 21  2    h.  Iowa foundation of medical care director.
 21  3    i.  State emergency medical services medical director.
 21  4    2.  Proceedings, records, and reports developed pursuant to
 21  5 this section constitute peer review records under section
 21  6 147.135, and are not subject to discovery by subpoena or
 21  7 admissible as evidence.  All information and documents
 21  8 received from a hospital or emergency care facility under this
 21  9 division shall be confidential pursuant to section 272C.6,
 21 10 subsection 4.
 21 11    Sec. 35.  NEW SECTION.  147A.26  TRAUMA REGISTRY.
 21 12    1.  The department shall maintain a statewide trauma
 21 13 reporting system by which the system evaluation and quality
 21 14 improvement committee, the trauma system advisory council, and
 21 15 the department may monitor the effectiveness of the statewide
 21 16 trauma care system.
 21 17    2.  The data collected by and furnished to the department
 21 18 pursuant to this section shall not be public records under
 21 19 chapter 22.  The compilations prepared for release or
 21 20 dissemination from the data collected shall be public records
 21 21 under chapter 22, which are not subject to section 22.7,
 21 22 subsection 2.  However, the confidentiality of patients is to
 21 23 be protected and the laws of this state apply with regard to
 21 24 patient confidentiality.
 21 25    3.  To the extent possible, activities under this section
 21 26 shall be coordinated with other health data collection
 21 27 methods.
 21 28    Sec. 36.  NEW SECTION.  147A.27  DEPARTMENT TO ADOPT RULES.
 21 29    The department shall adopt rules, pursuant to chapter 17A,
 21 30 to implement the Iowa trauma care system plan, which specify
 21 31 all of the following:
 21 32    1.  Standards for trauma care.
 21 33    2.  Triage and transfer protocols.
 21 34    3.  Trauma registry procedures and policies.
 21 35    4.  Trauma care education and training requirements.
 22  1    5.  Hospital and emergency care facility categorization
 22  2 criteria.
 22  3    6.  Procedures for approval, denial, probation, and
 22  4 revocation of certificates of verification.
 22  5    Sec. 37.  NEW SECTION.  147A.28  EMERGENCY CARE &endash; DEFENSE.
 22  6    In an action for personal injury or wrongful death against
 22  7 an emergency care provider or an emergency care facility based
 22  8 upon the alleged negligence of the provider or facility,
 22  9 adherence to the Iowa trauma care system plan, rules, or
 22 10 protocols established under this division shall be an absolute
 22 11 defense against an allegation that the provider did not comply
 22 12 with the appropriate standard of care.
 22 13    Sec. 38.  NEW SECTION.  147A.29  PROHIBITED ACTS.
 22 14    A hospital or emergency care facility that imparts or
 22 15 conveys, or causes to be imparted or conveyed, that it is a
 22 16 trauma care facility, or that uses any other term to indicate
 22 17 or imply that the hospital or emergency care facility is a
 22 18 trauma care facility without having obtained a certificate of
 22 19 verification under this division is subject to a civil penalty
 22 20 not to exceed one hundred dollars per day for each offense.
 22 21 In addition, the director may apply to the district court for
 22 22 a writ of injunction to restrain the use of the term "trauma
 22 23 care facility".
 22 24    Sec. 39.  Section 152B.11, unnumbered paragraph 3, Code
 22 25 1995, is amended to read as follows:
 22 26    This section does not apply to persons who are licensed to
 22 27 practice a health profession covered by chapter 147 or to any
 22 28 person who performs respiratory care procedures as a first
 22 29 responder, emergency rescue technician, emergency medical
 22 30 technician-ambulance, advanced emergency medical care
 22 31 provider, or other person functioning as part of a rescue unit
 22 32 or in a hospital as authorized by chapter 147A, or to persons
 22 33 whose function with respect to respiratory care is limited to
 22 34 the home delivery and connection of oxygen tanks.
 22 35    Sec. 40.  Section 232.68, subsection 5, Code 1995, is
 23  1 amended to read as follows:
 23  2    5.  "Health practitioner" includes a licensed physician and
 23  3 surgeon, osteopath, osteopathic physician and surgeon,
 23  4 dentist, optometrist, podiatrist or chiropractor; a resident
 23  5 or intern in any of such professions; a licensed dental
 23  6 hygienist, a registered nurse or licensed practical nurse; and
 23  7 a basic an emergency medical care provider certified under
 23  8 section 147.161 or an advanced emergency medical care provider
 23  9 certified under section 147A.6.
 23 10    Sec. 41.  Section 321.423, subsection 1, Code 1995, is
 23 11 amended to read as follows:
 23 12    1.  DEFINITIONS.  As used in this section, unless the
 23 13 context otherwise requires:
 23 14    a.  "Advanced emergency Emergency medical care provider"
 23 15 means as defined in section 147A.1.
 23 16    b.  "Basic emergency medical care provider" means as
 23 17 defined in section 147.1.
 23 18    c. b.  "Fire department" means a paid or volunteer fire
 23 19 protection service provided by a benefited fire district under
 23 20 chapter 357B or by a county, municipality or township, or a
 23 21 private corporate organization that has a valid contract to
 23 22 provide fire protection service for a benefited fire district,
 23 23 county, municipality, township or governmental agency.
 23 24    d. c.  "Member" means a person who is a member in good
 23 25 standing of a fire department or a person who is an advanced
 23 26 or basic emergency medical care provider employed by an
 23 27 ambulance, rescue, or first responder service.
 23 28    Sec. 42.  NEW SECTION.  321.444A  HELMETS.
 23 29    1.  A motorcycle, motorized bicycle, or bicycle shall not
 23 30 be operated upon a highway unless the person who is operating
 23 31 or riding the motorcycle, motorized bicycle, or bicycle is
 23 32 wearing protective headgear which complies with standards and
 23 33 specifications established under 49 C.F.R. } 571.218.  For
 23 34 purposes of this section, "wearing protective headgear" means
 23 35 having a safety helmet on the person's head that is fastened
 24  1 with the helmet straps and that is of a size that fits the
 24  2 person's head securely without excessive lateral or vertical
 24  3 movement.
 24  4    2.  A person shall not possess for the purpose of sale,
 24  5 offer for sale, or sell protective headgear for use by a
 24  6 person operating or riding a motorcycle, motorized bicycle, or
 24  7 bicycle unless the protective headgear meets the standards and
 24  8 specifications required under this section.
 24  9    Sec. 43.  Section 422.7, Code 1995, is amended by adding
 24 10 the following new subsection:
 24 11    NEW SUBSECTION.  32.  Subtract, to the extent not otherwise
 24 12 deducted in computing adjusted gross income, the amounts paid
 24 13 by the taxpayer for the purchase of health insurance for the
 24 14 taxpayer or taxpayer's spouse or dependent.  
 24 15    Sec. 44.  Section 453A.13, subsection 3, Code 1995, is
 24 16 amended to read as follows:
 24 17    3.  FEES &endash; EXPIRATION.  All permits provided for in this
 24 18 division shall expire on June 30 of each year.  A permit shall
 24 19 not be granted or issued until the applicant has paid for the
 24 20 period ending June 30 next, to the department or the city or
 24 21 county granting the permit, the fees provided for in this
 24 22 division.  The annual state permit fee for a distributor,
 24 23 cigarette vendor, and wholesaler is one hundred dollars when
 24 24 the permit is granted during the months of July, August, or
 24 25 September.  However, whenever a state permit holder operates
 24 26 more than one place of business, a duplicate state permit
 24 27 shall be issued for each additional place of business on
 24 28 payment of five dollars for each duplicate state permit, but
 24 29 refunds as provided in this division do not apply to any
 24 30 duplicate permit issued.
 24 31    The minimum fee schedule for retail permits is as follows
 24 32 when the permit is granted during the months of July, August,
 24 33 or September:
 24 34    a.  In places outside any city, fifty dollars.
 24 35    b.  In cities of less than fifteen thousand population,
 25  1 seventy-five dollars.
 25  2    c.  In cities of fifteen thousand or more population, one
 25  3 hundred dollars.
 25  4    If any permit is granted during the months of October,
 25  5 November, or December, the fee shall be three-fourths of the
 25  6 above maximum schedule annual fee; if granted during the
 25  7 months of January, February, or March, one-half of the maximum
 25  8 schedule annual fee, and if granted during the months of
 25  9 April, May, or June, one-fourth of the maximum schedule annual
 25 10 fee.
 25 11    The city or county may establish fees above the minimum fee
 25 12 schedule.  All retail permit fees above the minimum fee
 25 13 schedule shall be retained by the city or county imposing the
 25 14 extra fee and shall be used by the state, city, or county for
 25 15 the exclusive purpose of enforcing section 453A.2.
 25 16    Sec. 45.  Section 453A.56, Code 1995, is amended to read as
 25 17 follows:
 25 18    453A.56  UNIFORM APPLICATION.
 25 19    1.  Enforcement of this chapter shall be implemented in an
 25 20 equitable manner throughout the state.  For the purpose of
 25 21 equitable and uniform implementation, application, and
 25 22 enforcement of state and local laws and regulations, the
 25 23 provisions of this chapter shall supersede any local law or
 25 24 regulation which is inconsistent with or conflicts with the
 25 25 provisions of this chapter.
 25 26    2.  Notwithstanding subsection 1, a city or county may
 25 27 establish fees for retail cigarette permits which are in
 25 28 excess of the minimum fee schedule established pursuant to
 25 29 section 453A.13.
 25 30    Sec. 46.  NEW SECTION.  505.22  SELF-FUNDED EMPLOYER-
 25 31 SPONSORED HEALTH BENEFIT PLAN PARTICIPATION IN IOWA INDIVIDUAL
 25 32 HEALTH BENEFIT REINSURANCE ASSOCIATION.
 25 33    1.  A self-funded employer-sponsored health benefit plan
 25 34 qualified under the federal Employee Retirement Income
 25 35 Security Act of 1974 may voluntarily elect to participate in
 26  1 the Iowa individual health benefit reinsurance association
 26  2 established in section 513C.10 in accordance with the plan of
 26  3 operation and subject to such terms and conditions adopted by
 26  4 the board of the association to provide portability and
 26  5 continuity to its covered employees and their covered spouses
 26  6 and dependents subject to the same terms and conditions as a
 26  7 participating insurer.
 26  8    2.  If the federal Employee Retirement Income Security Act
 26  9 of 1974 is amended such that the state may require the
 26 10 participation of a self-funded employer, the individual
 26 11 reinsurance requirements shall apply equally to such
 26 12 employers.
 26 13    3.  When and if the federal government imposes conditions
 26 14 of portability and continuity on self-funded employers
 26 15 qualified under the federal Employee Retirement Income
 26 16 Security Act of 1974 that the commissioner deems are
 26 17 substantially similar to those required of Iowa insurers,
 26 18 coverage under such qualified plan shall be deemed qualified
 26 19 prior coverage for purposes of chapters 513B and 513C.
 26 20    Sec. 47.  Section 507B.4, subsection 1, Code 1995, is
 26 21 amended by adding the following new paragraph:
 26 22    NEW PARAGRAPH.  k.  Misrepresents the access to health care
 26 23 practitioners under a managed care health plan.  The
 26 24 commissioner shall adopt rules providing for monitoring of
 26 25 such plans.
 26 26    Sec. 48.  Section 513B.2, subsection 12, paragraph a,
 26 27 subparagraph (3), Code 1995, is amended to read as follows:
 26 28    (3)  The individual requests enrollment within thirty sixty
 26 29 days after termination of the qualifying previous coverage.
 26 30    Sec. 49.  Section 513B.2, subsection 12, paragraph c, Code
 26 31 1995, is amended to read as follows:
 26 32    c.  A court has ordered that coverage be provided for a
 26 33 spouse or minor or dependent child under a covered employee's
 26 34 health benefit plan and the request for enrollment is made
 26 35 within thirty sixty days after issuance of the court order.
 27  1    Sec. 50.  Section 513B.37, subsection 1, paragraph a, Code
 27  2 1995, is amended to read as follows:
 27  3    a.  What benefits or direct pay requirements must be
 27  4 minimally included in a basic or standard benefit coverage
 27  5 policy or subscription contract.
 27  6    Sec. 51.  Section 513B.38, Code 1995, is amended by adding
 27  7 the following new subsection:
 27  8    NEW SUBSECTION.  4.  Upon the determination of the
 27  9 commissioner pursuant to section 513B.37, subsection 1,
 27 10 paragraph "a", to include expanded preventative care services
 27 11 and mental health and substance abuse treatment coverage, the
 27 12 commissioner shall do all of the following:
 27 13    a.  Adopt by rule, with all due diligence, requirements for
 27 14 the provision of expanded coverage for benefits for expanded
 27 15 preventative care services.
 27 16    b.  Adopt by rule, with all due diligence, requirements for
 27 17 the provision of coverage for benefits for mental health and
 27 18 substance abuse services.
 27 19    Sec. 52.  NEW SECTION.  513B.44  INDIVIDUAL HEALTH PLAN
 27 20 PREMIUM CREDIT.
 27 21    1.  The division shall adopt rules to implement and
 27 22 administer the premium credit authorized by this section,
 27 23 which rules shall include the minimum standard application
 27 24 form for premium credit eligibility.  Forms shall be printed
 27 25 by participating insurance companies, health maintenance
 27 26 organizations, or health insurance purchasing cooperatives and
 27 27 provided to individuals wishing to apply for premium credit
 27 28 eligibility.
 27 29    2.  The amount of the premium credit is equal to twenty-
 27 30 five dollars per month, per participating eligible individual
 27 31 or fifty dollars per month per eligible family purchasing a
 27 32 health plan from an insurer, health maintenance organization,
 27 33 or organized delivery system authorized to do business in this
 27 34 state, whether purchased directly or through a health
 27 35 insurance purchasing cooperative.
 28  1    3.  An individual or family is eligible for participation
 28  2 in the subsidized insurance premium credit health insurance
 28  3 plan if the family income is less than or equal to two hundred
 28  4 percent of the federal poverty level as published annually in
 28  5 the federal register by the United States department of health
 28  6 and human services.  An application for eligibility is valid
 28  7 for up to one year.  Notwithstanding the income requirement of
 28  8 this subsection, the division by rule may increase the income
 28  9 limitation for the purpose of increasing the number of
 28 10 eligible individuals and families to assure that the premium
 28 11 credit is fully utilized to the extent authorized in this
 28 12 section.
 28 13    4.  The earned premium credit is limited to the first full-
 28 14 year equivalent participating eligible applications submitted
 28 15 under this section preapproved by the division in any single
 28 16 fiscal year, which request in the aggregate four million five
 28 17 hundred thousand dollars in earned premium credit.
 28 18    5.  The carrier shall credit to the participating
 28 19 individual's or family's premium liability, an amount equal to
 28 20 the premium credit earned pursuant to subsection 2.  If
 28 21 purchased through a health insurance purchasing cooperative,
 28 22 the cooperative shall reduce the member assessment to the
 28 23 individual or family by an equal amount.
 28 24    6.  The premium credit provided by this section is only
 28 25 available in connection with either of the following:
 28 26    a.  A basic benefit plan approved by the commissioner.
 28 27    b.  A major medical policy approved by the commissioner
 28 28 providing coverage to an eligible individual or family, either
 28 29 on a group or individual basis.  An individual or family may
 28 30 acquire group coverage for which they are financially
 28 31 responsible through an employer's participation in a health
 28 32 insurance purchasing cooperative.
 28 33    7.  The policy shall also satisfy any conditions imposed by
 28 34 rules adopted pursuant to subsection 1 which the commissioner
 28 35 determines are necessary or convenient to implement and
 29  1 administer the premium credit.
 29  2    8.  a.  A person submitting an intentionally fraudulent
 29  3 premium credit application forfeits the credit and shall pay
 29  4 to the division a liquidated damages penalty of one hundred
 29  5 fifty percent of the credit forfeited.
 29  6    b.  A person submitting a premium credit application which
 29  7 that person should have known was false forfeits the credit
 29  8 and shall pay to the division a liquidated damages penalty of
 29  9 ten percent of the credit forfeited.
 29 10    9.  The insurance carrier shall receive a premium tax
 29 11 credit equal to, at minimum, the premium credit earned by the
 29 12 carrier's insureds pursuant to subsection 2.
 29 13    10.  The division shall submit an annual report to the
 29 14 general assembly concerning the number of eligible applicants
 29 15 for the individual health plan premium credit established in
 29 16 this section, the number of applications approved and the
 29 17 aggregate amount of premium credits issued to eligible
 29 18 applicants, and the number and amount of liquidated damage
 29 19 penalties assessed and collected.
 29 20    Sec. 53.  NEW SECTION.  513C.1  SHORT TITLE.
 29 21    This chapter shall be known and may be cited as the
 29 22 "Individual Health Insurance Market Reform Act".
 29 23    Sec. 54.  NEW SECTION.  513C.2  PURPOSE.
 29 24    The purpose and intent of this chapter is to promote the
 29 25 availability of health insurance coverage to individuals
 29 26 regardless of their health status or claims experience, to
 29 27 prevent abusive rating practices, to require disclosure of
 29 28 rating practices to purchasers, to establish rules regarding
 29 29 the renewal of coverage, to establish limitations on the use
 29 30 of preexisting condition exclusions, to assure fair access to
 29 31 health plans, and to improve the overall fairness and
 29 32 efficiency of the individual health insurance market.
 29 33    Sec. 55.  NEW SECTION.  513C.3  DEFINITIONS.
 29 34    As used in this chapter, unless the context otherwise
 29 35 requires:
 30  1    1.  "Actuarial certification" means a written statement by
 30  2 a member of the American academy of actuaries or other
 30  3 individual acceptable to the commissioner that an individual
 30  4 carrier is in compliance with the provision of section 513C.5
 30  5 which is based upon the actuary's or individual's examination,
 30  6 including a review of the appropriate records and the
 30  7 actuarial assumptions and methods used by the carrier in
 30  8 establishing premium rates for applicable individual health
 30  9 benefit plans.
 30 10    2.  "Affiliate" or "affiliated" means any entity or person
 30 11 who directly or indirectly through one or more intermediaries,
 30 12 controls or is controlled by, or is under common control with,
 30 13 a specified entity or person.
 30 14    3.  "Basic or standard health benefit plan" means the core
 30 15 group of health benefits developed pursuant to section 513C.8.
 30 16    4.  "Block of business" means all the individuals insured
 30 17 under the same individual health benefit plan.
 30 18    5.  "Carrier" means any entity that provides individual
 30 19 health benefit plans in this state.  For purposes of this
 30 20 chapter, carrier includes an insurance company, a group
 30 21 hospital or medical service corporation, a fraternal benefit
 30 22 society, a health maintenance organization, and any other
 30 23 entity providing an individual plan of health insurance or
 30 24 health benefits subject to state insurance regulation.
 30 25    6.  "Commissioner" means the commissioner of insurance.
 30 26    7.  "Director" means the director of public health
 30 27 appointed pursuant to section 135.2.
 30 28    8.  "Eligible individual" means an individual who is a
 30 29 resident of this state and who either has qualifying existing
 30 30 coverage or has had qualifying existing coverage within the
 30 31 immediately preceding thirty days, or an individual who has
 30 32 had a qualifying event occur within the immediately preceding
 30 33 thirty days.
 30 34    9.  "Established service area" means a geographic area, as
 30 35 approved by the commissioner and based upon the carrier's
 31  1 certificate of authority to transact business in this state,
 31  2 within which the carrier is authorized to provide coverage or
 31  3 a geographic area, as approved by the director and based upon
 31  4 the organized delivery system's license to transact business
 31  5 in this state, within which the organized delivery system is
 31  6 authorized to provide coverage.
 31  7    10.  "Filed rate" means, for a rating period related to
 31  8 each block of business, the rate charged to all individuals
 31  9 with similar rating characteristics for individual health
 31 10 benefit plans.
 31 11    11.  "Individual health benefit plan" means any hospital or
 31 12 medical expense incurred policy or certificate, hospital or
 31 13 medical service plan, or health maintenance organization
 31 14 subscriber contract sold to an individual, or any
 31 15 discretionary group trust or association policy providing
 31 16 hospital or medical expense incurred coverage to individuals.
 31 17 Individual health benefit plan does not include a self-insured
 31 18 group health plan, a self-insured multiple employer group
 31 19 health plan, a group conversion plan, an insured group health
 31 20 plan, accident-only, specified disease, short-term hospital or
 31 21 medical, hospital confinement indemnity, credit, dental,
 31 22 vision, medicare supplement, long-term care, or disability
 31 23 income insurance coverage, coverage issued as a supplement to
 31 24 liability insurance, workers' compensation or similar
 31 25 insurance, or automobile medical payment insurance.
 31 26    12.  "Organized delivery system" means an organized
 31 27 delivery system licensed by the director.
 31 28    13.  "Premium" means all moneys paid by an individual and
 31 29 eligible dependents as a condition of receiving coverage from
 31 30 a carrier or an organized delivery system, including any fees
 31 31 or other contributions associated with an individual health
 31 32 benefit plan.
 31 33    14.  "Qualifying event" means any of the following:
 31 34    a.  Loss of eligibility for medical assistance provided
 31 35 pursuant to chapter 249A or medicare coverage provided
 32  1 pursuant to Title XVIII of the federal Social Security Act.
 32  2    b.  Loss or change of dependent status under qualifying
 32  3 previous coverage.
 32  4    c.  The attainment by an individual of the age of majority.
 32  5    15.  "Qualifying existing coverage" or "qualifying previous
 32  6 coverage" means benefits or coverage provided under any of the
 32  7 following:
 32  8    a.  Any group health insurance that provides benefits
 32  9 similar to or exceeding benefits provided under the standard
 32 10 health benefit plan, provided that such policy has been in
 32 11 effect for a period of at least one year.
 32 12    b.  An individual health insurance benefit plan, including
 32 13 coverage provided under a health maintenance organization
 32 14 contract, a hospital or medical service plan contract, or a
 32 15 fraternal benefit society contract, that provides benefits
 32 16 similar to or exceeding the benefits provided under the
 32 17 standard health benefit plan, provided that such policy has
 32 18 been in effect for a period of at least one year.
 32 19    c.  An organized delivery system that provides benefits
 32 20 similar to or exceeding the benefits provided under the
 32 21 standard health benefit plan, provided that the benefits
 32 22 provided by the organized delivery system have been in effect
 32 23 for a period of at least one year.
 32 24    16.  "Rating characteristics" means demographic or other
 32 25 objective characteristics of individuals which are considered
 32 26 by the carrier in the determination of premium rates for the
 32 27 individuals and which are approved by the commissioner.
 32 28    17.  "Rating period" means the period for which premium
 32 29 rates established by a carrier are in effect.
 32 30    18.  "Restricted network provision" means a provision of an
 32 31 individual health benefit plan that conditions the payment of
 32 32 benefits, in whole or in part, on the use of health care
 32 33 providers that have entered into a contractual arrangement
 32 34 with the carrier or the organized delivery system to provide
 32 35 health care services to covered individuals.
 33  1    Sec. 56.  NEW SECTION.  513C.4  APPLICABILITY AND SCOPE.
 33  2    This chapter applies to an individual health benefit plan
 33  3 delivered or issued for delivery to residents of this state on
 33  4 or after July 1, 1995.
 33  5    1.  Except as provided in subsection 2, for purposes of
 33  6 this chapter, carriers that are affiliated companies or that
 33  7 are eligible to file a consolidated tax return shall be
 33  8 treated as one carrier and any restrictions or limitations
 33  9 imposed by this chapter shall apply as if all individual
 33 10 health benefit plans delivered or issued for delivery to
 33 11 residents of this state by such affiliated carriers were
 33 12 issued by one carrier.
 33 13    2.  An affiliated carrier that is a health maintenance
 33 14 organization having a certificate of authority under section
 33 15 513C.5 shall be considered to be a separate carrier for the
 33 16 purposes of this chapter.
 33 17    Sec. 57.  NEW SECTION.  513C.5  RESTRICTIONS RELATING TO
 33 18 PREMIUM RATES.
 33 19    1.  Premium rates for any block of individual health
 33 20 benefit plan business issued on or after July 1, 1995, by a
 33 21 carrier subject to this chapter are subject to the composite
 33 22 effect of all of the following:
 33 23    a.  After making actuarial adjustments based upon benefit
 33 24 design and rating characteristics, the filed rate for any
 33 25 block of business shall not exceed the filed rate for any
 33 26 other block of business by more than twenty percent.
 33 27    b.  The filed rate for any block of business shall not
 33 28 exceed the filed rate for any other block of business by more
 33 29 than thirty percent due to factors relating to rating
 33 30 characteristics.
 33 31    c.  The filed rate for any block of business shall not
 33 32 exceed the filed rate for any other block of business by more
 33 33 than thirty percent due to any other factors approved by the
 33 34 commissioner.
 33 35    d.  Rating characteristics other than age, geographic area,
 34  1 and family composition shall not be used by a carrier without
 34  2 the prior approval of the commissioner.
 34  3    e.  Premium rates for individual health benefit plans shall
 34  4 comply with the requirements of this section notwithstanding
 34  5 any assessments paid or payable by the carrier pursuant to any
 34  6 reinsurance program or risk adjustment mechanism.
 34  7    f.  An adjustment, not to exceed fifteen percent annually
 34  8 due to the claim experience or health status of a block of
 34  9 business.
 34 10    g.  For purposes of this subsection, an individual health
 34 11 benefit plan that contains a restricted network provision
 34 12 shall not be considered similar coverage to an individual
 34 13 health benefit plan that does not contain such a provision,
 34 14 provided that the differential in payments made to network
 34 15 providers results in substantial differences in claim costs.
 34 16    2.  Notwithstanding subsection 1, the commissioner, with
 34 17 the concurrence of the board of the Iowa individual health
 34 18 benefit reinsurance association established in section
 34 19 513C.10, may by order reduce or eliminate the allowed rating
 34 20 bands provided under subsection 1, paragraphs "a", "b", "c",
 34 21 and "f", or otherwise limit or eliminate the use of experience
 34 22 rating.  The commissioner shall also develop a recommendation
 34 23 for the elimination of age as a rating characteristic, and
 34 24 shall submit such recommendation by January 8, 1996.
 34 25    3.  A carrier shall not transfer an individual
 34 26 involuntarily into or out of a block of business.
 34 27    4.  The commissioner may suspend for a specified period the
 34 28 application of subsection 1, paragraph "a", as to the premium
 34 29 rates applicable to one or more blocks of business of a
 34 30 carrier for one or more rating periods upon a filing by the
 34 31 carrier requesting the suspension and a finding by the
 34 32 commissioner that the suspension is reasonable in light of the
 34 33 financial condition of the carrier.
 34 34    5.  A carrier shall make a reasonable disclosure at the
 34 35 time of the offering for sale of any individual health benefit
 35  1 plan of all of the following:
 35  2    a.  The extent to which premium rates for a specified
 35  3 individual are established or adjusted based upon rating
 35  4 characteristics.
 35  5    b.  The carrier's right to change premium rates, and the
 35  6 factors, other than claim experience, that affect changes in
 35  7 premium rates.
 35  8    c.  The provisions relating to the renewal of policies and
 35  9 contracts.
 35 10    d.  Any provisions relating to any preexisting condition.
 35 11    e.  All plans offered by the carrier, the prices of such
 35 12 plans, and the availability of such plans to the individual.
 35 13    6.  A carrier shall maintain at its principal place of
 35 14 business a complete and detailed description of its rating
 35 15 practices, including information and documentation that
 35 16 demonstrate that its rating methods and practices are based
 35 17 upon commonly accepted actuarial assumptions and are in
 35 18 accordance with sound actuarial principles.
 35 19    7.  A carrier shall file with the commissioner annually on
 35 20 or before March 15, an actuarial certification certifying that
 35 21 the carrier is in compliance with this chapter and that the
 35 22 rating methods of the carrier are actuarially sound.  The
 35 23 certification shall be in a form and manner and shall contain
 35 24 information as specified by the commissioner.  A copy of the
 35 25 certification shall be retained by the carrier at its
 35 26 principal place of business.  Rate adjustments made in order
 35 27 to comply with this section are exempt from loss ratio
 35 28 requirements.
 35 29    8.  A carrier shall make the information and documentation
 35 30 maintained pursuant to subsection 5 available to the
 35 31 commissioner upon request.  The information and documentation
 35 32 shall be considered proprietary and trade secret information
 35 33 and shall not be subject to disclosure by the commissioner to
 35 34 persons outside of the division except as agreed to by the
 35 35 carrier or as ordered by a court of competent jurisdiction.
 36  1    Sec. 58.  NEW SECTION.  513C.6  RENEWAL OF COVERAGE.
 36  2    1.  An individual health benefit plan is renewable at the
 36  3 option of the individual, except in any of the following
 36  4 cases:
 36  5    a.  Nonpayment of the required premiums.
 36  6    b.  Fraud or misrepresentation.
 36  7    c.  The insured individual becomes eligible for medicare
 36  8 coverage under Title XVIII of the federal Social Security Act.
 36  9    d.  The carrier elects not to renew all of its individual
 36 10 health benefit plans in the state.  In such case, the carrier
 36 11 shall provide notice of the decision not to renew coverage to
 36 12 all affected individuals and to the commissioner in each state
 36 13 in which an affected insured individual is known to reside at
 36 14 least ninety days prior to the nonrenewal of the health
 36 15 benefit plan by the carrier.  Notice to the commissioner under
 36 16 this paragraph shall be provided at least three working days
 36 17 prior to the notice to the affected individuals.
 36 18    e.  The commissioner finds that the continuation of the
 36 19 coverage would not be in the best interests of the
 36 20 policyholders or certificate holders, or would impair the
 36 21 carrier's ability to meet its contractual obligations.
 36 22    2.  A carrier that elects not to renew all of its
 36 23 individual health benefit plans in this state shall be
 36 24 prohibited from writing new individual health benefit plans in
 36 25 this state for a period of five years from the date of the
 36 26 notice to the commissioner.
 36 27    3.  With respect to a carrier doing business in an
 36 28 established geographic service area of the state, this section
 36 29 applies only to the carrier's operations in the service area.
 36 30    Sec. 59.  NEW SECTION.  513C.7  AVAILABILITY OF COVERAGE.
 36 31    1.  A carrier or an organized delivery system issuing an
 36 32 individual health benefit plan in this state shall issue a
 36 33 basic or standard health benefit plan to an eligible
 36 34 individual who applies for a plan and agrees to make the
 36 35 required premium payments and to satisfy other reasonable
 37  1 provisions of the basic or standard health benefit plan.  A
 37  2 carrier or an organized delivery system is not required to
 37  3 issue a basic or standard health benefit plan to an individual
 37  4 who meets any of the following criteria:
 37  5    a.  The individual is covered or is eligible for coverage
 37  6 under a health benefit plan provided by the individual's
 37  7 employer.
 37  8    b.  An eligible individual who does not apply for a basic
 37  9 or standard health benefit plan within thirty days of a
 37 10 qualifying event or within thirty days upon becoming
 37 11 ineligible for qualifying existing coverage.
 37 12    c.  The individual is covered or is eligible for any
 37 13 continued group coverage under section 4980b of the Internal
 37 14 Revenue Code, sections 601 through 608 of the federal Employee
 37 15 Retirement Income Security Act of 1974, sections 2201 through
 37 16 2208 of the federal Public Health Service Act, or any state-
 37 17 required continued group coverage.  For purposes of this
 37 18 subsection, an individual who would have been eligible for
 37 19 such continuation of coverage, but is not eligible solely
 37 20 because the individual or other responsible party failed to
 37 21 make the required coverage election during the applicable time
 37 22 period, is deemed to be eligible for such group coverage until
 37 23 the date on which the individual's continuing group coverage
 37 24 would have expired had an election been made.
 37 25    2.  A carrier or an organized delivery system shall issue
 37 26 the basic or standard health benefit plan to an individual
 37 27 currently covered by an underwritten benefit plan issued by
 37 28 that carrier or an organized delivery system at the option of
 37 29 the individual.  This option must be exercised within thirty
 37 30 days of notification of a premium rate increase applicable to
 37 31 the underwritten benefit plan.
 37 32    3.  a.  A carrier shall file with the commissioner, in a
 37 33 form and manner prescribed by the commissioner, the basic or
 37 34 standard health benefit plan to be used by the carrier.  A
 37 35 basic or standard health benefit plan filed pursuant to this
 38  1 paragraph may be used by a carrier beginning thirty days after
 38  2 it is filed unless the commissioner disapproves of its use.
 38  3    The commissioner may at any time, after providing notice
 38  4 and an opportunity for a hearing to the carrier, disapprove
 38  5 the continued use by a carrier of a basic or standard health
 38  6 benefit plan on the grounds that the plan does not meet the
 38  7 requirements of this chapter.
 38  8    b.  An organized delivery system shall file with the
 38  9 director, in a form and manner prescribed by the director, the
 38 10 basic or standard health benefit plan to be used by the
 38 11 organized delivery system.  A basic or standard health benefit
 38 12 plan filed pursuant to this paragraph may be used by the
 38 13 organized delivery system beginning thirty days after it is
 38 14 filed unless the director disapproves of its use.
 38 15    The director may at any time, after providing notice and an
 38 16 opportunity for a hearing to the organized delivery system,
 38 17 disapprove the continued use by an organized delivery system
 38 18 of a basic or standard health benefit plan on the grounds that
 38 19 the plan does not meet the requirements of this chapter.
 38 20    4.  a.  The individual basic or standard health benefit
 38 21 plan shall not deny, exclude, or limit benefits for a covered
 38 22 individual for losses incurred more than twelve months
 38 23 following the effective date of the individual's coverage due
 38 24 to a preexisting condition.  A preexisting condition shall not
 38 25 be defined more restrictively than any of the following:
 38 26    (1)  A condition that would cause an ordinarily prudent
 38 27 person to seek medical advice, diagnosis, care, or treatment
 38 28 during the twelve months immediately preceding the effective
 38 29 date of coverage.
 38 30    (2)  A condition for which medical advice, diagnosis, care,
 38 31 or treatment was recommended or received during the twelve
 38 32 months immediately preceding the effective date of coverage.
 38 33    (3)  A pregnancy existing on the effective date of
 38 34 coverage.
 38 35    b.  A carrier or an organized delivery system shall waive
 39  1 any time period applicable to a preexisting condition
 39  2 exclusion or limitation period with respect to particular
 39  3 services in an individual health benefit plan for the period
 39  4 of time an individual was previously covered by qualifying
 39  5 previous coverage that provided benefits with respect to such
 39  6 services, provided that the qualifying previous coverage was
 39  7 continuous to a date not more than thirty days prior to the
 39  8 effective date of the new coverage.
 39  9    5.  A carrier or an organized delivery system is not
 39 10 required to offer coverage or accept applications pursuant to
 39 11 subsection 1 from any individual not residing in the carrier's
 39 12 or the organized delivery system's established geographic
 39 13 access area.
 39 14    6.  A carrier or an organized delivery system shall not
 39 15 modify a basic or standard health benefit plan with respect to
 39 16 an individual or dependent through riders, endorsements, or
 39 17 other means to restrict or exclude coverage for certain
 39 18 diseases or medical conditions otherwise covered by the health
 39 19 benefit plan.
 39 20    Sec. 60.  NEW SECTION.  513C.8  HEALTH BENEFIT PLAN
 39 21 STANDARDS.
 39 22    The commissioner shall adopt by rule the form and level of
 39 23 coverage of the basic health benefit plan and the standard
 39 24 health benefit plan for the individual market which shall be
 39 25 substantially similar to those as provided for under chapter
 39 26 513B with respect to small group coverage.
 39 27    Sec. 61.  NEW SECTION.  513C.9  STANDARDS TO ASSURE FAIR
 39 28 MARKETING.
 39 29    1.  A carrier or an organized delivery system issuing
 39 30 individual health benefit plans in this state shall make
 39 31 available the basic or standard health benefit plan to
 39 32 residents of this state.  If a carrier or an organized
 39 33 delivery system denies other individual health benefit plan
 39 34 coverage to an eligible individual on the basis of the health
 39 35 status or claims experience of the eligible individual, or the
 40  1 individual's dependents, the carrier or the organized delivery
 40  2 system shall offer the individual the opportunity to purchase
 40  3 a basic or standard health benefit plan.
 40  4    2.  A carrier, or an organized delivery system, or an agent
 40  5 shall not do either of the following:
 40  6    a.  Encourage or direct individuals to refrain from filing
 40  7 an application for coverage with the carrier or the organized
 40  8 delivery system because of the health status, claims
 40  9 experience, industry, occupation, or geographic location of
 40 10 the individuals.
 40 11    b.  Encourage or direct individuals to seek coverage from
 40 12 another carrier or another organized delivery system because
 40 13 of the health status, claims experience, industry, occupation,
 40 14 or geographic location of the individuals.
 40 15    3.  Subsection 2, paragraph "a", shall not apply with
 40 16 respect to information provided by a carrier or an organized
 40 17 delivery system or an agent to an individual regarding the
 40 18 established geographic service area of the carrier or the
 40 19 organized delivery system, or the restricted network provision
 40 20 of the carrier or the organized delivery system.
 40 21    4.  A carrier or an organized delivery system shall not,
 40 22 directly or indirectly, enter into any contract, agreement, or
 40 23 arrangement with an agent that provides for, or results in,
 40 24 the compensation paid to an agent for a sale of a basic or
 40 25 standard health benefit plan to vary because of the health
 40 26 status or permitted rating characteristics of the individual
 40 27 or the individual's dependents.
 40 28    5.  Subsection 4 does not apply with respect to the
 40 29 compensation paid to an agent on the basis of percentage of
 40 30 premium, provided that the percentage shall not vary because
 40 31 of the health status or other permitted rating characteristics
 40 32 of the individual or the individual's dependents.
 40 33    6.  Denial by a carrier or an organized delivery system of
 40 34 an application for coverage from an individual shall be in
 40 35 writing and shall state the reason or reasons for the denial.
 41  1    7.  A violation of this section by a carrier or an agent is
 41  2 an unfair trade practice under chapter 507B.
 41  3    8.  If a carrier or an organized delivery system enters
 41  4 into a contract, agreement, or other arrangement with a third-
 41  5 party administrator to provide administrative, marketing, or
 41  6 other services related to the offering of individual health
 41  7 benefit plans in this state, the third-party administrator is
 41  8 subject to this section as if it were a carrier or an
 41  9 organized delivery system.
 41 10    Sec. 62.  NEW SECTION.  513C.10  IOWA INDIVIDUAL HEALTH
 41 11 BENEFIT REINSURANCE ASSOCIATION.
 41 12    1.  A nonprofit corporation is established to be known as
 41 13 the Iowa individual health benefit reinsurance association.
 41 14 All persons that provide health benefit plans in this state
 41 15 including insurers providing accident and sickness insurance
 41 16 under chapter 509, 514, or 514A; fraternal benefit societies
 41 17 providing hospital, medical, or nursing benefits under chapter
 41 18 512B; health maintenance organizations, organized delivery
 41 19 systems, and all other entities providing health insurance or
 41 20 health benefits subject to state insurance regulation shall be
 41 21 members of this association.  The association shall be
 41 22 incorporated under chapter 504A, shall operate under a plan of
 41 23 operation established and approved pursuant to chapter 504A,
 41 24 and shall exercise its powers through a board of directors
 41 25 established under this section.
 41 26    2.  The initial board of directors of the association shall
 41 27 consist of seven members appointed by the commissioner as
 41 28 follows:
 41 29    a.  Four members shall be representatives of the four
 41 30 largest carriers of individual health insurance in the state,
 41 31 excluding medicare supplement coverage premiums, as of the
 41 32 calendar year ending December 31, 1994.
 41 33    b.  Three members shall be representatives of the three
 41 34 largest writers of health insurance in the state which are not
 41 35 otherwise represented.
 42  1    After an initial term, board members shall be nominated and
 42  2 elected by the members of the association.
 42  3    Members of the board may be reimbursed from the funds of
 42  4 the association for expenses incurred by them as members, but
 42  5 shall not otherwise be compensated by the association for
 42  6 their services.
 42  7    3.  The association shall submit to the commissioner a plan
 42  8 of operation for the association and any amendments to the
 42  9 association's articles of incorporation necessary and
 42 10 appropriate to assure the fair, reasonable, and equitable
 42 11 administration of the association.  The plan shall provide for
 42 12 the sharing of losses related to basic and standard plans, if
 42 13 any, on an equitable and proportional basis among the members
 42 14 of the association.  If the association fails to submit a
 42 15 suitable plan of operation within one hundred eighty days
 42 16 after the appointment of the board of directors, the
 42 17 commissioner shall adopt rules necessary to implement this
 42 18 section.  The rules shall continue in force until modified by
 42 19 the commissioner or superseded by a plan submitted by the
 42 20 association and approved by the commissioner.  In addition to
 42 21 other requirements, the plan of operation shall provide for
 42 22 all of the following:
 42 23    a.  The handling and accounting of assets and funds of the
 42 24 association.
 42 25    b.  The amount of and method for reimbursing the expenses
 42 26 of board members.
 42 27    c.  Regular times and places for meetings of the board of
 42 28 directors.
 42 29    d.  Records to be kept relating to all financial
 42 30 transactions, and annual fiscal reporting to the commissioner.
 42 31    e.  Procedures for selecting the board of directors.
 42 32    f.  Additional provisions necessary or proper for the
 42 33 execution of the powers and duties of the association.
 42 34    4.  The plan of operation may provide that the powers and
 42 35 duties of the association may be delegated to a person who
 43  1 will perform functions similar to those of the association.  A
 43  2 delegation under this section takes effect only upon the
 43  3 approval of the board of directors.
 43  4    5.  The association has the general powers and authority
 43  5 enumerated by this section and executed in accordance with the
 43  6 plan of operation approved by the commissioner under
 43  7 subsection 3.  In addition, the association may do any of the
 43  8 following:
 43  9    a.  Enter into contracts as necessary or proper to
 43 10 administer this chapter.
 43 11    b.  Sue or be sued, including taking any legal action
 43 12 necessary or proper for recovery of any assessments for, on
 43 13 behalf of, or against members of the association or other
 43 14 participating persons.
 43 15    c.  Appoint from among members appropriate legal,
 43 16 actuarial, and other committees as necessary to provide
 43 17 technical assistance in the operation of the association,
 43 18 including the hiring of independent consultants as necessary.
 43 19    d.  Perform any other functions within the authority of the
 43 20 association.
 43 21    6.  Rates for basic and standard coverages as provided in
 43 22 this chapter shall be determined by each carrier or organized
 43 23 delivery system as the average of the lowest rate available
 43 24 for issuance by that carrier or organized delivery system
 43 25 adjusted for rate characteristics and benefits and the maximum
 43 26 rate allowable by law after adjustments for rate
 43 27 characteristics and benefits.
 43 28    7.  Following the close of each calendar year, the
 43 29 association, in conjunction with the commissioner, shall
 43 30 require each carrier or organized delivery system to report
 43 31 the amount of earned premiums and the associated paid losses
 43 32 for all basic and standard plans issued by the carrier or
 43 33 organized delivery system.  The reporting of these amounts
 43 34 must be certified by an officer of the carrier or the
 43 35 organized delivery system.
 44  1    8.  The board shall determine the amount of loss, if any,
 44  2 from all basic and standard plans issued in the state by all
 44  3 carriers and organized delivery systems by aggregating the
 44  4 data reported in subsection 7.  A loss shall be equal to
 44  5 ninety percent of earned premiums minus total paid claims.
 44  6    9.  The loss plus necessary operating expenses for the
 44  7 association, plus any additional expenses as provided by law,
 44  8 shall be assessed by the association to all members in
 44  9 proportion to their respective shares of total health
 44 10 insurance premiums or payments for subscriber contracts
 44 11 received in Iowa during the second preceding calendar year, or
 44 12 with paid losses in the year, coinciding with or ending during
 44 13 the calendar year, or on any other equitable basis as provided
 44 14 in the plan of operation.  In sharing losses, the association
 44 15 may abate or defer any part of the assessment of a member, if,
 44 16 in the opinion of the board, payment of the assessment would
 44 17 endanger the ability of the member to fulfill its contractual
 44 18 obligations.  The association may also provide for an initial
 44 19 or interim assessment against members of the association if
 44 20 necessary to assure the financial viability of the association
 44 21 to meet the operating expenses of the association until the
 44 22 next calendar year is completed.
 44 23    10.  The collected assessments shall be disbursed to a
 44 24 carrier or an organized delivery system in proportion to the
 44 25 loss that carrier or organized delivery system represented of
 44 26 the aggregate loss as determined in subsection 8.
 44 27    11.  A carrier or an organized delivery system may petition
 44 28 the association board to seek remedy from writing a
 44 29 significantly disproportionate share of basic and standard
 44 30 policies in relation to total premiums written in the state
 44 31 for health benefit plans.  Upon a finding that a carrier or an
 44 32 organized delivery system has written a disproportionate
 44 33 share, the board may agree to compensate the carrier or the
 44 34 organized delivery system either by paying to the carrier or
 44 35 the organized delivery system an additional fee not to exceed
 45  1 two percent of earned premiums from basic and standard
 45  2 policies for that carrier or organized delivery system or by
 45  3 petitioning the commissioner or director, as appropriate, for
 45  4 remedy.
 45  5    12.  a.  The commissioner, upon a finding that the
 45  6 acceptance of the offer of basic and standard coverage by
 45  7 individuals pursuant to this chapter would place the
 45  8 individual health insurance carrier in a financially impaired
 45  9 condition, shall not require the carrier to offer coverage or
 45 10 accept applications for any period of time the financial
 45 11 impairment is deemed to exist.
 45 12    b.  The director, upon a finding that the acceptance of the
 45 13 offer of basic and standard coverage by individuals pursuant
 45 14 to this chapter would place the organized delivery system in a
 45 15 financially impaired condition, shall not require the
 45 16 organized delivery system to offer coverage or accept
 45 17 applications for any period of time the financial impairment
 45 18 is deemed to exist.
 45 19    Sec. 63.  NEW SECTION.  513C.11  INSURANCE DIVISION
 45 20 REPORTS.
 45 21    1.  The insurance division shall annually provide a written
 45 22 report to the general assembly beginning January 1, 1996,
 45 23 which evaluates the effect of this chapter on providing
 45 24 universal coverage for all Iowans.  This report may be
 45 25 completed in conjunction with the report required by section
 45 26 505.21 relating to the establishment of a requirement that an
 45 27 employer provide access to health care to the employer's
 45 28 employees.
 45 29    2.  The insurance division shall submit an annual report to
 45 30 the general assembly on or before January 15 of each year
 45 31 concerning the aggregate number of insureds who have coverage
 45 32 through an individual health benefit plan issued under this
 45 33 chapter and the net increase or decrease in the number of
 45 34 insureds from the previous year.  
 45 35    Sec. 64.  Section 724.6, subsection 2, Code 1995, is
 46  1 amended to read as follows:
 46  2    2.  Notwithstanding subsection 1, fire fighters, as defined
 46  3 in section 411.1, subsection 9, airport fire fighters included
 46  4 under section 97B.49, subsection 16, paragraph "b",
 46  5 subparagraph (2), emergency medical technicians-ambulance and
 46  6 emergency rescue technicians, as defined in section 147.1, and
 46  7 advanced emergency medical care providers, as defined in
 46  8 section 147A.1, shall not, as a condition of employment, be
 46  9 required to obtain a permit under this section.  However, the
 46 10 provisions of this subsection shall not apply to a person
 46 11 designated as an arson investigator by the chief fire officer
 46 12 of a political subdivision.
 46 13    Sec. 65.  Section 805.8, subsection 2, paragraph e, Code
 46 14 1995, is amended to read as follows:
 46 15    e.  For improperly used or nonused or defective or improper
 46 16 equipment under sections 321.383, 321.384, 321.385, 321.386,
 46 17 321.398, 321.402, 321.403, 321.404, 321.409, 321.419, 321.420,
 46 18 321.423, 321.430, and 321.433, the scheduled fine is twenty
 46 19 dollars.  For failing to wear protective headgear as required
 46 20 under section 321.444A, the scheduled fine is fifty dollars
 46 21 for an operator and twenty-five dollars for a passenger.
 46 22    Sec. 66.  Section 147.161, Code 1995, is repealed.
 46 23    Sec. 67.  INSURANCE DIVISION STUDIES.  The insurance
 46 24 division shall review, study, and make recommendations to the
 46 25 general assembly concerning the Iowa comprehensive health
 46 26 insurance association established under chapter 514E, with the
 46 27 intent to merge the Iowa comprehensive health insurance
 46 28 program with an individual health reinsurance program.  The
 46 29 division shall submit a written report to the general assembly
 46 30 no later than January 8, 1996, including the division's
 46 31 findings and recommendations.
 46 32    It is the intent of the general assembly that any merger of
 46 33 the Iowa comprehensive health insurance program with an
 46 34 individual health reinsurance program shall only occur if
 46 35 those whom the Iowa comprehensive health insurance association
 47  1 presently serves or would serve in the future are able to
 47  2 obtain health coverage equal to or better than such coverage
 47  3 in terms of cost, coverage, and plan restrictions than
 47  4 presently available through the Iowa comprehensive health
 47  5 insurance association.
 47  6    Sec. 68.  INTERIM STUDY REQUEST.  The legislative council
 47  7 is requested to establish an interim study committee to review
 47  8 the potential for adoption of a variety of plans which may be
 47  9 formed to enable an individual or family to participate in
 47 10 financial instruments which provide for accumulation of
 47 11 deposits for the potential payment of health care
 47 12 expenditures.  In particular, the committee should review the
 47 13 potential offered by family health accounts and their
 47 14 applicability in the provision of health security for
 47 15 individuals and families.  Issues to be reviewed shall include
 47 16 limitations on deposits, extent of usage for health care
 47 17 expenditures, tax consequences, extent to which deposits can
 47 18 be used, the role of financial institutions, withdrawal
 47 19 parameters, and penalties.  A report with recommendations
 47 20 shall be presented to the general assembly no later than
 47 21 January 3, 1996.
 47 22    Sec. 69.  STUDY PROPOSAL.  The insurance division, on or
 47 23 before September 1, 1995, shall provide a written proposal to
 47 24 the legislative council of the general assembly, and the
 47 25 chairperson, vice chairperson, and ranking member of the
 47 26 Senate and House committees on human resources detailing a
 47 27 plan for the study of all available financing mechanisms and
 47 28 cost containment mechanisms which might assist in the
 47 29 attainment of universal coverage for all Iowa citizens.
 47 30    Sec. 70.  CONTINGENCY.  Implementation of sections 8
 47 31 through 10 of this Act is contingent upon the receipt of
 47 32 federal funding specifically for the implementation of a
 47 33 program to train and certify lead inspectors and lead abaters.
 47 34    Sec. 71.  IMPLEMENTATION.  The trauma system advisory
 47 35 council and the Iowa department of public health, in
 48  1 implementing the Iowa trauma care system plan under this Act,
 48  2 shall utilize the findings and recommendation contained in the
 48  3 Iowa trauma care plan developed and adopted by the Iowa trauma
 48  4 systems project planning consortium.  The consortium was
 48  5 organized through the Iowa department of public health in
 48  6 October 1992 to develop a statewide trauma care delivery
 48  7 system.  The consortium included representatives from
 48  8 hospitals, physician groups, other health care professionals,
 48  9 and state departments involved in health care delivery.  The
 48 10 consortium is abolished upon establishment of the trauma
 48 11 system advisory council.
 48 12    Sec. 72.  APPLICABILITY.  Notwithstanding the provisions of
 48 13 sections 513C.4 and 513C.5, chapter 513C, as enacted in this
 48 14 Act, is not applicable to an individual health benefit plan
 48 15 delivered or issued for delivery in this state or to a block
 48 16 of individual health benefit plan business until such time as
 48 17 rules implementing the chapter have been adopted by the
 48 18 insurance division pursuant to chapter 17A.
 48 19    Sec. 73.  EFFECTIVE DATE.  Section 43 of this Act, which
 48 20 amends section 422.7 by adding a new subsection 32, is
 48 21 effective January 1, 1996, for tax years beginning on or after
 48 22 that date.  
 48 23                           EXPLANATION
 48 24    This bill relates to health care reform and health care
 48 25 costs by amending or creating provisions relating to emergency
 48 26 medical services, lead poisoning, tobacco sales, insurance
 48 27 regulation, safety equipment to be worn by individuals,
 48 28 establishing a tax deduction, and requiring certain state
 48 29 agency studies.
 48 30    The bill consolidates Code regulation of emergency medical
 48 31 services (EMS) into chapter 147A, eliminating previous
 48 32 references to basic EMS providers in chapter 147 and other
 48 33 sections of the Code.  An EMS advisory council is established
 48 34 to advise the director on policy and administration.  The bill
 48 35 requires the department to inspect and license all EMS
 49  1 services.  Those services previously not regulated which
 49  2 experience undue hardship with immediately complying with
 49  3 these regulations may be granted variances by the director.
 49  4 The bill allows the department to define by rule the skills of
 49  5 the three levels of EMS providers and clarifies the role of
 49  6 the EMS provider.  Sections 1, 2, 3, 4, 5, 11, 12, 14, 19, 20,
 49  7 22, 23, 26, 39 40, 41, 64, and 66 make necessary terminology
 49  8 changes consistent with the consolidation of the regulation of
 49  9 emergency medical services into chapter 147A.
 49 10    Sections 6 through 10 of the bill authorize the Iowa
 49 11 department of public health to develop rules for the
 49 12 inspection and mitigation of lead hazards in the case of lead-
 49 13 poisoned children.  The department is also required to
 49 14 establish a training and certification program for lead
 49 15 inspectors and lead abaters contingent upon receipt of federal
 49 16 funding.
 49 17    Section 135.104 is amended to change the emphasis of the
 49 18 lead screening program for children from less than age five to
 49 19 less than age six.
 49 20    Section 135.105 is amended to require the department to
 49 21 adopt rules by January 1, 1996, for the inspection and
 49 22 mitigation of lead hazards in cases of lead-poisoned children.
 49 23    New section 135.105A creates a lead inspector and abater
 49 24 certification program.
 49 25    New section 135.105B requires the department to adopt
 49 26 standards for inspection for lead hazards and the abatement of
 49 27 lead hazards including lead hazards found in privately owned
 49 28 homes and rental property.
 49 29    New section 135.105C prohibits individuals from training
 49 30 lead inspectors and abaters, conducting lead inspections for
 49 31 compensation, or abating lead hazards for compensation unless
 49 32 certified, beginning July 1, 1996.  The bill imposes a civil
 49 33 penalty of up to $5,000 per violation beginning January 1,
 49 34 1997.
 49 35    Section 142B.6 is amended to strike the prohibition on
 50  1 local authorities to enact stricter ordinances regarding
 50  2 smoking in public places.
 50  3    Section 147A.1 is amended to provide that the term "EMS
 50  4 provider" is expanded to include all levels of provider.  The
 50  5 emergency rescue technician and instructor certification is
 50  6 added.  Emergency medical services and nonemergency is
 50  7 defined.
 50  8    Sections 147A.2 and 147A.3 are amended to establish the EMS
 50  9 advisory council.
 50 10    Section 147A.4 is amended and applies service regulations
 50 11 to all EMS service providers and allows the director to grant
 50 12 variances in cases of hardship.
 50 13    Section 147A.7 is amended and allows the board to issue,
 50 14 deny, revoke, or suspend EMS provider certificates.
 50 15    Section 147A.9 states that the department shall adopt
 50 16 medical care procedures which can be started by EMS personnel
 50 17 before remote supervision commences or in the failure of
 50 18 remote supervision.
 50 19    Section 147A.10 is amended to add registered nurses to EMS
 50 20 personnel who are exempt from liability if following orders
 50 21 from a physician, physician's designee, or physician assistant
 50 22 at the scene of an emergency and adds registered nurses to
 50 23 those individuals not subject to civil liability only for not
 50 24 obtaining consent before starting emergency aid.
 50 25    Sections 147A.12 and 147A.13 are amended and establish the
 50 26 department as being jointly responsible for developing rules
 50 27 governing nurses and physician assistants in emergency care
 50 28 roles.
 50 29    The bill creates new sections 147A.20 through 147A.29 which
 50 30 provide the department of public health with the authority to
 50 31 develop and implement a coordinated system for the delivery of
 50 32 acute trauma care for injured Iowans.  This system of care
 50 33 would include development of care criteria for hospitals and
 50 34 other emergency care facilities, protocols for treatment of
 50 35 injuries, and patient transfer guidelines for referrals from
 51  1 one institution to another.  The department would receive
 51  2 advice and counsel from an advisory council consisting of
 51  3 providers from representative groups as specified in the bill.
 51  4 System oversight and evaluation would be achieved through data
 51  5 collection in a trauma system registry and analyzed by a
 51  6 quality assurance committee.
 51  7    New section 147A.20 creates a new division in chapter 147A
 51  8 and is appropriately titled.
 51  9    New section 147A.21 adds definitions which are used in this
 51 10 division.
 51 11    New section 147A.22 provides legislative findings and
 51 12 purpose.
 51 13    New section 147A.23 designates the department of public
 51 14 health as the lead agency for the implementation of a
 51 15 statewide trauma care system.  The department would categorize
 51 16 all hospitals and emergency care facilities to determine their
 51 17 capabilities to provide acute trauma care.  After this
 51 18 categorization, all categorized facilities would then go
 51 19 through a verification process.  The department is given the
 51 20 authority to establish fees to help defray costs.
 51 21    New section 147A.24 creates the trauma system advisory
 51 22 council to assist the department in implementing this bill.
 51 23    New section 147A.25 creates a system evaluation committee
 51 24 and provides confidentiality protection for the peer review
 51 25 activities of the committee.
 51 26    New section 147A.26 establishes a data reporting process to
 51 27 monitor and evaluate the implementation and effectiveness of
 51 28 the system.
 51 29    New section 147A.27 gives the department the authority to
 51 30 adopt rules.
 51 31    New section 147A.28 extends immunity from civil liability
 51 32 to providers practicing under the protocols established under
 51 33 the bill.
 51 34    New section 147A.29 allows the department to enjoin and
 51 35 assess a civil penalty against hospitals or emergency care
 52  1 facilities which misrepresent their trauma care capabilities
 52  2 as certified under the bill.
 52  3    New section 321.444A requires persons who are operating or
 52  4 riding a motorcycle, motorized bicycle, or bicycle on the
 52  5 highway to wear protective headgear.  It also prohibits a
 52  6 person from possessing for sale, offering for sale, or selling
 52  7 protective headgear which does not meet federal standards and
 52  8 specifications.  A person who does so may be charged with a
 52  9 simple misdemeanor which is punishable by a fine of at least
 52 10 $50 but no more than $100 or up to 30 days' imprisonment.
 52 11    Section 422.7 is amended to implement the deduction of 100
 52 12 percent of a taxpayer's cost for the purchase of health
 52 13 insurance from adjusted gross income in computing state
 52 14 individual income tax.
 52 15    Section 453A.13 is amended to modify the current retail fee
 52 16 schedule to allow the city and county governments to increase
 52 17 fees to fund enforcement of under-aged tobacco purchase laws.
 52 18    Section 453A.56 is amended to enable local government
 52 19 discretion in increasing retail permit fees.
 52 20    New section 505.22 is created which provides that a self-
 52 21 funded employer-sponsored health benefit plan qualified under
 52 22 the federal Employee Retirement Incomes Security Act of 1974
 52 23 may voluntarily elect to participate in the individual
 52 24 reinsurance pool to provide portability and continuity to the
 52 25 employer's covered employees and their spouses and dependents
 52 26 subject to the same terms and conditions as a participating
 52 27 insurer.
 52 28    Section 507B.4, subsection 1, which relates to unfair
 52 29 methods of competition and unfair or deceptive acts, is
 52 30 amended to include the misrepresentation by an individual of
 52 31 access to health care practitioners under a managed care
 52 32 health plan.
 52 33    Section 513B.2, subsection 12, which defines a late
 52 34 enrollee for purposes of small group health coverage, is
 52 35 amended to not include an individual, or a spouse or minor
 53  1 dependent child under a court order requiring coverage, who,
 53  2 in addition to existing requirements, requests enrollment
 53  3 within 60 days after termination of qualifying previous
 53  4 coverage for an individual, or within 60 days after the
 53  5 issuance of the court order.  Currently, such request for
 53  6 coverage must be made within 30 days.
 53  7    Section 513B.37 is amended to provide that the commissioner
 53  8 is to determine what benefits or direct pay requirements must
 53  9 be minimally included in a standard health benefit plan.
 53 10    Section 513B.38 is amended to provide that the commissioner
 53 11 may extend standard benefits to include preventative care
 53 12 services and mental health and substance abuse treatment
 53 13 coverage.
 53 14    New section 513B.44 is created and directs the insurance
 53 15 division to implement and administer a premium credit to be
 53 16 provided to individuals wishing to apply for the premium
 53 17 credit.
 53 18    New chapter 513C is created relating to individual health
 53 19 coverage.  New section 513C.1 provides the title, the
 53 20 Individual Health Insurance Market Reform Act.
 53 21    New section 513C.2 states the purpose of the chapter.
 53 22    New section 513C.3 establishes the definitions of key terms
 53 23 used in the chapter.
 53 24    New section 513C.4 provides that the chapter applies to an
 53 25 individual health benefit plan delivered or issued for
 53 26 delivery to residents in this state on or after July 1, 1995.
 53 27    New section 513C.5 establishes restrictions relating to
 53 28 premium rates for individual health benefit plans.  Among
 53 29 those factors, the carrier is not to apply gender or industry
 53 30 classification rating characteristics, and experience rating
 53 31 characteristics only apply when an individual who is obtaining
 53 32 health coverage does not currently have qualifying coverage,
 53 33 as defined in the chapter.  Certain other restrictions apply
 53 34 relating to the transfer of an individual into and out of a
 53 35 block of business, and required disclosures relating to the
 54  1 coverage are enumerated.
 54  2    New section 513C.6 relates to the renewal of an individual
 54  3 health benefit plan.  Such plan is renewable at the option of
 54  4 the individual, except under certain enumerated circumstances.
 54  5 The section also provides that a carrier that elects not to
 54  6 renew all of its individual health benefit plans in this state
 54  7 shall be prohibited from writing new individual health benefit
 54  8 plans in this state for a period of five years from the date
 54  9 of the notice required to be provided to the commissioner of
 54 10 such election.
 54 11    New section 513C.7 provides that a carrier issuing
 54 12 individual health benefit plans must issue such plan to an
 54 13 individual applying for the plan except under certain defined
 54 14 circumstances.
 54 15    New section 513C.8 provides that the commissioner is to
 54 16 adopt rules relating to the form and level of coverage of the
 54 17 basic and standard health benefit plan for the individual
 54 18 market.
 54 19    New section 513C.9 establishes standards to assure fair
 54 20 marketing of individual basic and standard health benefit
 54 21 plans.  Restrictions are also established relating to carrier
 54 22 and the agent concerning the marketing of such plans.
 54 23    New section 513C.10 establishes an Iowa individual health
 54 24 benefit reinsurance association to provide for the sharing of
 54 25 losses related to basic and standard plans, if any, on an
 54 26 equitable and proportional basis among the members of the
 54 27 association.
 54 28    New section 513C.11 is established requiring the insurance
 54 29 division to annually report to the general assembly regarding
 54 30 the effect of new chapter 513C on providing universal coverage
 54 31 for all Iowans, and regarding the number of aggregate number
 54 32 of insureds who have coverage through an individual health
 54 33 benefit plan issued under chapter 513C.
 54 34    Section 805.8 is amended to provide a scheduled fine for
 54 35 failure to wear protective headgear of $50 for the operator
 55  1 and $25 for the passenger.
 55  2    The bill directs the insurance division to review, develop,
 55  3 and submit a plan for the establishment of an individual
 55  4 health coverage reinsurance program.  The division is also to
 55  5 provide a written proposal on or before September 1, 1995,
 55  6 detailing all available financing and cost containment
 55  7 mechanisms which might assist in attaining universal coverage
 55  8 for all Iowans.
 55  9    The bill also provides that the tax deduction established
 55 10 in chapter 422 is effective for tax years beginning on or
 55 11 after January 1, 1996.
 55 12    The bill requests the legislative council to establish an
 55 13 interim committee to review the potential for adoption of a
 55 14 variety of plans which may be formed to enable an individual
 55 15 or family to participate in financial instruments which
 55 16 provide for accumulation of deposits for the potential payment
 55 17 of health care expenditures.  
 55 18 LSB 1179SC 76
 55 19 mj/sc/14.2
     

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