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PAG LIN
1 1 Section 1. NEW SECTION. 507B.15 UTILIZATION REVIEW.
1 2 1. For the purposes of this section, "third-party payor"
1 3 means any of the following:
1 4 a. An insurer subject to chapter 509 or 514A.
1 5 b. A health service corporation subject to chapter 514.
1 6 c. A health maintenance organization subject to chapter
1 7 514B.
1 8 d. A preferred provider arrangement subject to rules of
1 9 the commissioner of insurance.
1 10 e. A multiple employer welfare arrangement.
1 11 f. A third-party administrator.
1 12 g. A fraternal benefit society.
1 13 h. An organized delivery system established under the
1 14 rules of the department of public health.
1 15 i. Any other benefit program providing payment,
1 16 reimbursement, or indemnification for health care costs for an
1 17 enrollee or an insured or an enrollee's or insured's eligible
1 18 dependents.
1 19 2. A third-party payor which provides health benefits to
1 20 insureds or enrollees residing in this state and which
1 21 conducts utilization review either directly or indirectly by
1 22 contract with an independent party shall satisfy both of the
1 23 following requirements:
1 24 a. The utilization review shall meet the requirements
1 25 established for accreditation by the utilization review
1 26 accreditation commission or other national accreditation
1 27 entity recognized and approved by the commissioner.
1 28 b. Health care providers conducting utilization review
1 29 must have a current unrestricted Iowa license to practice
1 30 medicine or another health profession.
1 31 EXPLANATION
1 32 This bill requires third-party payors of health benefits
1 33 which conduct utilization review to comply with requirements
1 34 of the utilization review accreditation commission. The bill
1 35 provides that health care providers conducting utilization
2 1 review are required to have an unrestricted Iowa license to
2 2 practice in their profession.
2 3 LSB 2024SC 77
2 4 mj/sc/14
Text: SSB00155 Text: SSB00157 Text: SSB00100 - SSB00199 Text: SSB Index Bills and Amendments: General Index Bill History: General Index
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