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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 1286DP 77
3 31 rn/cf/24
Text: SSB00069 Text: SSB00071 Text: SSB00000 - SSB00099 Text: SSB Index Bills and Amendments: General Index Bill History: General Index
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