Text: SF00107 Text: SF00109 Text: SF00100 - SF00199 Text: SF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. NEW SECTION. 514I.1 SHORT TITLE. 1 2 This chapter shall be known and may be cited as the 1 3 "Patient Right To Know Act". 1 4 Sec. 2. NEW SECTION. 514I.2 DEFINITIONS. 1 5 As used in this section, unless the context otherwise 1 6 requires: 1 7 1. "Health care provider" means a person licensed under 1 8 Title IV, subtitle 3, of the Code, to provide health care 1 9 services. 1 10 2. "Health plan" means any public or private health plan 1 11 or arrangement offered by an insurance company, health 1 12 maintenance organization, or organized delivery system that 1 13 provides or pays the cost of health benefits, and includes an 1 14 organization or network of health care providers who furnish 1 15 health services for such plan under contract with the entity 1 16 offering the plan. 1 17 3. "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 the health plan 1 21 or another health plan relating to such needs or treatment 1 22 made by a health care provider to any of the following: a 1 23 current, former, or prospective patient or the patient's 1 24 guardian or legal representative; an employee or 1 25 representative of the entity offering the health plan; or an 1 26 employee or representative of any state or federal authority 1 27 with responsibility for the licensing or oversight of such 1 28 entity or health plan. Medical communications include, but 1 29 are not limited to, communications concerning any tests, 1 30 consultations, or treatment options; any risks or benefits 1 31 associated with such tests, consultations, or options; 1 32 variation among health care providers and institutions 1 33 providing such services in experience, quality, or outcomes; 1 34 the basis or standard for the decision of an entity offering a 1 35 health plan to authorize or deny health care services or 2 1 benefits; the process used by such an entity to determine 2 2 whether to authorize or deny health care services or benefits; 2 3 and any financial incentives or disincentives provided by such 2 4 an entity to a health care provider that are based on service 2 5 utilization. 2 6 Sec. 3. NEW SECTION. 514I.3 PROHIBITION OF INTERFERENCE 2 7 WITH MEDICAL COMMUNICATIONS – LIMITATIONS. 2 8 1. An entity delivering, amending, or renewing a contract 2 9 to offer a health plan on or after July 1, 1997, shall not 2 10 provide, as part of a contract with a health care provider, 2 11 any restriction on or interference with a medical 2 12 communication. A contract delivered, amended, or renewed 2 13 prior to July 1, 1997, shall comply with this prohibition 2 14 within thirty days. 2 15 2. a. An entity offering a health plan shall not take any 2 16 of the following actions against a health care provider on the 2 17 basis of a medical communication: 2 18 (1) Refusal to contract with the health care provider. 2 19 (2) Termination of or refusal to renew a contract with the 2 20 health care provider. 2 21 (3) Refusal to refer patients to or allow others to refer 2 22 patients to the health care provider. 2 23 (4) Refusal to compensate the health care provider for 2 24 covered services. 2 25 (5) Any other retaliatory action against the health care 2 26 provider. 2 27 b. The prohibition against retaliatory actions applies to 2 28 actions taken on or after July 1, 1997, notwithstanding the 2 29 date of the occurrence of the medical communication upon which 2 30 the retaliatory action is based. 2 31 3. A provision in a health plan contract that is 2 32 prohibited under subsection 1 is deemed null and void. 2 33 4. This chapter shall not be construed as preventing an 2 34 entity offering a health plan from acting on information 2 35 relating to treatment actually provided to a patient or the 3 1 failure of a health care provider to comply with legal 3 2 standards relating to the provision of care. 3 3 EXPLANATION 3 4 This bill prohibits insurance companies, health maintenance 3 5 organizations, and organized delivery systems from restricting 3 6 or interfering with the medical communications between a 3 7 health care provider and the health care provider's patients 3 8 or employees of the entity offering the health plan or of a 3 9 state or federal licensing or oversight authority. The bill 3 10 also prohibits an entity which provides a health plan from 3 11 taking retaliatory action against a health care provider based 3 12 on medical communications. Any agreements or arrangements 3 13 prohibited by the bill immediately are deemed null and void. 3 14 However, health plans are given 30 days from enactment of the 3 15 bill to comply with the provisions of the bill. 3 16 LSB 1844XS 77 3 17 pf/sc/14
Text: SF00107 Text: SF00109 Text: SF00100 - SF00199 Text: SF Index Bills and Amendments: General Index Bill History: General Index
© 1997 Cornell College and League of Women Voters of Iowa
Comments? webmaster@legis.iowa.gov.
Last update: Tue Feb 18 03:40:03 CST 1997
URL: /DOCS/GA/77GA/Legislation/SF/00100/SF00108/970204.html
jhf