Text: S03413 Text: S03415 Text: S03400 - S03499 Text: S Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend House File 133, as amended, passed, and
1 2 reprinted by the House, as follows:
1 3 #1. Page 3, by inserting after line 8 the
1 4 following:
1 5 "Sec. . NEW SECTION. 514C.14 PATIENT ACCESS
1 6 TO TYPES OF PHYSICIANS UNDER MANAGED CARE HEALTH PLAN
1 7 OR INDEMNITY PLAN WITH LIMITED PROVIDER NETWORK.
1 8 Notwithstanding section 514C.6, a managed care
1 9 health plan or indemnity plan with a limited provider
1 10 network shall provide patients direct access to each
1 11 type of physician, as defined in section 135.1 and
1 12 licensed under chapter 148, 150A, or 151. Direct
1 13 access to a physician licensed under chapter 151 shall
1 14 not be conditioned upon a referral by a provider
1 15 licensed under another chapter. Access to a
1 16 specialist may be conditioned upon a referral by a
1 17 primary care provider physician licensed under chapter
1 18 148, 150A, or 151. If a physician licensed under
1 19 chapter 151 determines that a referral should be made
1 20 to a physician licensed under another chapter, a
1 21 managed care health plan or indemnity plan with a
1 22 limited provider network may require that the referral
1 23 be made first to a provider designated by the plan.
1 24 Any copayment deductible, cost containment mechanism,
1 25 or premium rate shall not discriminate directly or
1 26 indirectly upon the basis of the license held by the
1 27 physician. Access to a specialist may be subject to a
1 28 different copayment or deductible than access to a
1 29 primary care provider. Access to a nonparticipating
1 30 physician may be restricted or may be subject to
1 31 different copayments, deductibles, or premium rates,
1 32 or may be excluded, provided that a plan shall not
1 33 differentiate or exclude a physician directly or
1 34 indirectly upon the basis of the license held by the
1 35 physician.
1 36 Each plan must demonstrate that it is capable of
1 37 serving appropriately the needs of the subscriber
1 38 population in the service area of the plan with regard
1 39 to patient access to each type of physician. The
1 40 commissioner of insurance shall adopt rules as
1 41 necessary to administer this paragraph.
1 42 For purposes of this section, "managed care health
1 43 plan or indemnity plan with a limited provider
1 44 network" means a health maintenance organization,
1 45 organized delivery system, accountable health plan,
1 46 health care insurance plan which limits the number of
1 47 licensed physicians who can provide services under the
1 48 plan, preferred provider organization, exclusive
1 49 provider organization, restricted access network, or
1 50 similar health-care plan. For purposes of this
2 1 section, "physician" means physician as defined in
2 2 section 135.1 and licensed under chapter 148, 150A, or
2 3 151."
2 4 #2. Renumber as necessary.
2 5
2 6
2 7
2 8 MARY LUNDBY
2 9 MICHAEL E. GRONSTAL
2 10 MERLIN E. BARTZ
2 11 PATTY JUDGE
2 12 STEVEN D. HANSEN
2 13 H. KAY HEDGE
2 14 JOHN W. JENSEN
2 15 PATRICK J. DELUHERY
2 16 WILLIAM D. PALMER
2 17 WILMER RENSINK
2 18 EUGENE S. FRAISE
2 19 JACK RIFE
2 20 HF 133.303 77
2 21 mj/jw/28
Text: S03413 Text: S03415 Text: S03400 - S03499 Text: S Index Bills and Amendments: General Index Bill History: General Index
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