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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