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House Journal: Page 1315: Tuesday, April 2, 1996

36   audiologist as defined in section 147.151, a person
37   engaged in the practice of osteopathy under chapter
38   150, an acupuncturist registered under chapter 148E,
39   an occupational therapist licensed under chapter 148B,
40   a podiatrist licensed under chapter 149, a registered
41   or practical nurse licensed under chapter 152,
42   dietician licensed under chapter 152A, a respiratory
43   care practitioner licensed under chapter 152B, a
44   massage therapist licensed under chapter 152C, each
45   dentist licensed under chapter 153, a person engaged
46   in the practice of optometry pursuant to chapter 154,
47   a hearing aid dealer licensed under chapter 154A, a
48   person engaged in the practice of psychology and
49   regulated under chapter 154B, a person engaged in the
50   practice of licensed social work and regulated under

Page 2  

 1   chapter 154C, a marital and family therapist licensed
 2   under chapter 154D, a pharmacist licensed under
 3   chapter 155A.  If a primary care provider determines
 4   that a referral should be made to a provider licensed,
 5   registered, or otherwise regulated under another
 6   chapter, a managed care health plan or indemnity plan
 7   with a limited provider network may require that the
 8   referral be made first to a provider designated by the
 9   plan.  Any copayment deductible, cost containment
10   mechanism, or premium rate shall not discriminate
11   directly or indirectly upon the basis of the license
12   held by the provider.  Access to a specialist may be
13   subject to a different copayment or deductible than
14   access to a primary care provider.  Access to a
15   nonparticipating provider may be restricted or may be
16   subject to different copayments, deductibles, or
17   premium rates, or may be excluded, provided that a
18   plan shall not differentiate or exclude a provider
19   directly or indirectly upon the basis of the license
20   held by the provider.
21     Each plan must demonstrate that it is capable of
22   serving appropriately the needs of the subscriber
23   population in the service area of the plan with regard
24   to patient access to each type of provider.  The
25   commissioner of insurance shall adopt rules as
26   necessary to administer this paragraph.
27     For purposes of this section, "managed care health
28   plan or indemnity plan with a limited provider
29   network" means a health maintenance organization,
30   organized delivery system, accountable health plan,
31   health care insurance plan which limits the number of
32   health care providers who can provide services under
33   the plan, preferred provider organization, exclusive
34   provider organization, restricted access network, or
35   similar health-care plan."

Iowa General Assembly

Index: House Journal (76th General Assembly: Session 2)

© 1996 Cornell College and League of Women Voters of Iowa

Comments? hjourn@legis.iowa.gov.

Last update: Wed Apr 3 13:30:03 CST 1996
URL: /DOCS/GA/76GA/Session.2/HJournal/01300/01315.html
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