Text: HF00240 Text: HF00242 Text: HF00200 - HF00299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. NEW SECTION. 135.29A PATIENT RIGHT-TO-KNOW 1 2 ACT. 1 3 1. As used in this section, unless the context otherwise 1 4 requires: 1 5 a. "Health care provider" means anyone licensed under 1 6 Title IV, subtitle 3, to provide health care services. 1 7 b. "Health plan" means any public or private health plan 1 8 or arrangement offered by an insurance company authorized to 1 9 do business in this state pursuant to Title III, subtitle 1, a 1 10 health maintenance organization issued a certificate of 1 11 authority pursuant to chapter 514B, or an organized delivery 1 12 system licensed pursuant to 1993 Iowa Acts, chapter 158, to 1 13 provide or pay health care costs, and includes an organization 1 14 or network of health care providers that furnishes health 1 15 services for such plans under contracts or agreements with the 1 16 licensed entity offering the plan. 1 17 c. "Medical communication" means any communication, other 1 18 than a knowing and willful misrepresentation, regarding the 1 19 mental or physical health care needs or treatment of a patient 1 20 and the provisions, terms, or requirements of a health plan 1 21 relating to such needs or treatment made by a health care 1 22 provider to: a current, former, or prospective patient or 1 23 their guardian or legal representative; an employee or 1 24 representative of the entity offering the health plan; or an 1 25 employee or representative of a state or federal authority 1 26 with responsibility for the licensing or oversight of such 1 27 entity or health plan. "Medical communication" includes, but 1 28 is not limited to, a communication concerning any of the 1 29 following: 1 30 (1) Tests, consultations, and treatment options, including 1 31 any risks or benefits associated with such tests, 1 32 consultation, or options. 1 33 (2) Variations among any health care providers and any 1 34 institutions providing such services in experience, quality, 1 35 or outcomes. 2 1 (3) The basis or standard for the decision of an entity 2 2 offering a health plan to authorize or deny health care 2 3 services or benefits. 2 4 (4) The process used by such an entity to determine 2 5 whether to authorize or deny health care services or benefits. 2 6 (5) Any financial incentives or disincentives provided by 2 7 such an entity to a health care provider that are based on 2 8 service utilization. 2 9 2. An entity offering a health plan shall not provide, as 2 10 part of any contract or agreement with a health care provider 2 11 or network of health care providers, any restriction on or 2 12 interference with any medical communication. A provision 2 13 containing such a restriction or interference shall be null 2 14 and void. 2 15 3. An entity offering a health plan shall not take any of 2 16 the following actions against a health care provider on the 2 17 basis of a medical communication: 2 18 a. Refusal to contract with the health care provider. 2 19 b. Termination of or refusal to renew a contract with the 2 20 health care provider. 2 21 c. Refusal to refer patients to or allow others to refer 2 22 patients to the health care provider. 2 23 d. Refusal to compensate the health care provider for 2 24 covered services. 2 25 e. Any other retaliatory action against the health care 2 26 provider. 2 27 4. This section shall not be construed as preventing an 2 28 entity offering a health plan from acting on information 2 29 relating to treatment actually provided to a patient or the 2 30 failure of a health care provider to comply with legal 2 31 standards relating to the provision of care. 2 32 Sec. 2. LIMITATIONS AND EFFECTIVE DATES. 2 33 1. This Act, being deemed of immediate importance, takes 2 34 effect upon enactment. 2 35 2. Section 1, subsection 2, shall apply to contracts or 3 1 agreements entered into or renewed on or after the effective 3 2 date of this Act, and to existing contracts and agreements 3 3 entered into before such date as of thirty days after such 3 4 date. 3 5 3. Section 1, subsection 3, shall apply to actions taken 3 6 on or after the effective date of this Act, regardless of when 3 7 the communication on which the action is based occurred. 3 8 EXPLANATION 3 9 This bill prohibits licensed insurance companies, health 3 10 maintenance organizations, and organized delivery systems from 3 11 restricting or interfering with medical communications of 3 12 health care providers with or on behalf of their patients. A 3 13 medical communication is defined in the bill to include any 3 14 communication, other than a knowing and willful 3 15 misrepresentation, regarding a patient's treatment and mental 3 16 or physical health care needs and the provisions of a health 3 17 plan related to such needs or treatment, between a health care 3 18 provider and a patient, the patient's legal representative, an 3 19 employee of an entity offering a health plan, or a state or 3 20 federal licensing or regulatory authority. The bill further 3 21 prohibits an entity offering a health plan from taking 3 22 retaliatory actions against health care providers based on 3 23 medical communications. Any agreements or arrangements 3 24 prohibited by the provisions of this bill would be immediately 3 25 null and void. However, entities offering health plans are 3 26 given 30 days from the effective date of this bill to delete 3 27 such prohibited arrangements from their existing provider 3 28 agreements. 3 29 This bill takes effect upon enactment. 3 30 LSB 1286YH 77 3 31 rn/cf/24
Text: HF00240 Text: HF00242 Text: HF00200 - HF00299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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