Text: H01166 Text: H01168 Text: H01100 - H01199 Text: H Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend Senate File 276, as amended, passed, and
1 2 reprinted by the Senate, as follows:
1 3 #1. Page 1, by inserting before line 1 the
1 4 following:
1 5 "Section 1. Section 509.3, subsection 6, Code
1 6 1999, is amended by striking the subsection.
1 7 Sec. . Section 514.7, unnumbered paragraph 3,
1 8 Code 1999, is amended by striking the unnumbered
1 9 paragraph.
1 10 Sec. . Section 514B.1, subsection 5, paragraph
1 11 c, Code 1999, is amended by striking the paragraph."
1 12 #2. Page 4, by inserting after line 7 the
1 13 following:
1 14 "Sec. . NEW SECTION. 514C.18 COMPARABLE
1 15 COVERAGE FOR MENTAL HEALTH TREATMENT.
1 16 1. Notwithstanding section 514C.6, a policy or
1 17 contract providing for third-party payment or
1 18 prepayment of health or medical expenses shall provide
1 19 coverage benefits for services for clinical disorders
1 20 related to mental health which shall be on terms and
1 21 conditions which are comparable to the terms and
1 22 conditions for coverage benefits provided for other
1 23 health or medical disorders under the policy or
1 24 contract.
1 25 2. For purposes of this section, clinical
1 26 disorders related to mental health for which coverage
1 27 benefits are to be provided under this section are
1 28 biological brain diseases including schizophrenia,
1 29 schizoaffective disorder, major depressive disorder,
1 30 bipolar disorder, paranoia and other psychotic
1 31 disorders, obsessive-compulsive disorder, panic
1 32 disorder, and pervasive developmental disorder or
1 33 autism.
1 34 3. This section applies to the following classes
1 35 of third-party payment provider contracts or policies
1 36 delivered, issued for delivery, continued, or renewed
1 37 in this state on or after July 1, 1999:
1 38 a. Individual or group accident and sickness
1 39 insurance providing coverage on an expense-incurred
1 40 basis.
1 41 b. An individual or group hospital or medical
1 42 service contract issued pursuant to chapter 509, 514,
1 43 or 514A.
1 44 c. An individual or group health maintenance
1 45 organization contract regulated under chapter 514B.
1 46 d. An individual or group Medicare supplemental
1 47 policy, unless coverage pursuant to such policy is
1 48 preempted by federal law.
1 49 e. Any other entity engaged in the business of
1 50 insurance, risk transfer, or risk retention, which is
2 1 subject to the jurisdiction of the commissioner.
2 2 f. An organized delivery system licensed by the
2 3 director of public health.
2 4 Sec. . NEW SECTION. 514C.19 MANDATED COVERAGE
2 5 FOR DENTAL CARE – ANESTHESIA AND CERTAIN HOSPITAL
2 6 CHARGES.
2 7 1. Notwithstanding section 514C.6, a policy or
2 8 contract providing for third-party payment or
2 9 prepayment of health or medical expenses shall provide
2 10 coverage for anesthesia and hospital charges related
2 11 to the provision of dental care services provided to
2 12 any of the following covered individuals:
2 13 a. A child under five years of age.
2 14 b. An individual who is severely disabled.
2 15 c. An individual who has a medical condition that
2 16 requires hospitalization or general anesthesia for
2 17 delivery of the dental care services.
2 18 2. A policy or contract providing for third-party
2 19 payment or prepayment of health or medical expenses
2 20 shall provide coverage for general anesthesia and
2 21 treatment rendered by a dentist for conditions covered
2 22 under such policy or contract, whether the services
2 23 are provided in a hospital or a dental office.
2 24 3. Prior authorization of hospitalization for
2 25 dental care procedures may be required in the same
2 26 manner that prior authorization is required for
2 27 hospitalization for other coverage under the contract
2 28 or policy.
2 29 4. This section applies to the following contracts
2 30 or policies delivered, issued for delivery, continued,
2 31 or renewed in this state on or after July 1, 1999:
2 32 a. Individual or group accident and sickness
2 33 insurance providing coverage on an expense-incurred
2 34 basis.
2 35 b. An individual or group hospital or medical
2 36 service contract issued pursuant to chapter 509, 514,
2 37 or 514A.
2 38 c. An individual or group health maintenance
2 39 organization contract regulated under chapter 514B.
2 40 d. An individual or group Medicare supplemental
2 41 policy, unless coverage pursuant to such policy is
2 42 preempted by federal law.
2 43 e. An organized delivery system licensed by the
2 44 director of public health.
2 45 Sec. . NEW SECTION. 514C.20 DIABETES
2 46 COVERAGE.
2 47 1. Notwithstanding the uniformity of treatment
2 48 requirements of section 514C.6, a policy or contract
2 49 providing for third-party payment or prepayment of
2 50 health or medical expenses shall provide coverage
3 1 benefits for the cost associated with equipment,
3 2 supplies, and self-management training and education
3 3 for the treatment of all types of diabetes mellitus
3 4 when prescribed by a physician licensed under chapter
3 5 148, 150, or 150A. Coverage benefits shall include
3 6 coverage for the cost associated with all of the
3 7 following:
3 8 a. Blood glucose meter and glucose strips for home
3 9 monitoring.
3 10 b. Payment for diabetes self-management training
3 11 and education only under all of the following
3 12 conditions:
3 13 (1) The physician managing the individual's
3 14 diabetic condition certifies that such services are
3 15 needed under a comprehensive plan of care related to
3 16 the individual's diabetic condition to ensure therapy
3 17 compliance or to provide the individual with necessary
3 18 skills and knowledge to participate in the management
3 19 of the individual's condition.
3 20 (2) The diabetic self-management training and
3 21 education program is certified by the Iowa department
3 22 of public health. The department shall consult with
3 23 the American diabetes association, Iowa affiliate, in
3 24 developing the standards for certification of diabetes
3 25 education programs as follows:
3 26 (a) Initial training shall cover up to ten hours
3 27 of initial outpatient diabetes self-management
3 28 training within a continuous twelve-month period for
3 29 each individual that meets any of the following
3 30 conditions:
3 31 (i) A new onset of diabetes.
3 32 (ii) Poor glycemic control as evidenced by a
3 33 glycosylated hemoglobin of nine and five-tenths or
3 34 more in the ninety days before attending the training.
3 35 (iii) A change in treatment regimen from no
3 36 diabetes medications to any diabetes medication, or
3 37 from oral diabetes medication to insulin.
3 38 (iv) High risk for complications based on poor
3 39 glycemic control; documented acute episodes of severe
3 40 hypoglycemia or acute severe hyperglycemia occurring
3 41 in the past year during which the individual needed
3 42 third-party assistance for either emergency room
3 43 visits or hospitalization.
3 44 (v) High risk based on documented complications of
3 45 a lack of feeling in the foot or other foot
3 46 complications such as foot ulcer or amputation, pre-
3 47 proliferative or proliferative retinopathy or prior
3 48 laser treatment of the eye, or kidney complications
3 49 related to diabetes, such as macroalbuminuria or
3 50 elevated creatinine.
4 1 (b) An individual who receives the initial
4 2 training shall be eligible for a single follow-up
4 3 training session of up to one hour each year.
4 4 2. a. This section applies to the following
4 5 classes of third-party payment provider contracts or
4 6 policies delivered, issued for delivery, continued, or
4 7 renewed in this state on or after July 1, 1999:
4 8 (1) Individual or group accident and sickness
4 9 insurance providing coverage on an expense-incurred
4 10 basis.
4 11 (2) An individual or group hospital or medical
4 12 service contract issued pursuant to chapter 509, 514,
4 13 or 514A.
4 14 (3) An individual or group health maintenance
4 15 organization contract regulated under chapter 514B.
4 16 (4) Any other entity engaged in the business of
4 17 insurance, risk transfer, or risk retention, which is
4 18 subject to the jurisdiction of the commissioner.
4 19 (5) A plan established pursuant to chapter 509A
4 20 for public employees.
4 21 (6) An organized delivery system licensed by the
4 22 director of public health.
4 23 b. This chapter shall not apply to accident only,
4 24 specified disease, short-term hospital or medical,
4 25 hospital confinement indemnity, credit, dental,
4 26 vision, Medicare supplement, long-term care, basic
4 27 hospital coverage, medical and surgical coverage,
4 28 disability income insurance coverage, coverage issued
4 29 as a supplement to liability insurance, workers'
4 30 compensation or similar insurance, or automobile
4 31 medical payment insurance."
4 32 #3. Title page, line 2, by inserting after the
4 33 word "care," the following: "mental health treatment,
4 34 anesthesia and certain hospital charges associated
4 35 with dental care services, diabetes coverage,".
4 36 #4. By renumbering as necessary.
4 37
4 38
4 39
4 40 GRUNDBERG of Polk
4 41
4 42
4 43
4 44 BLODGETT of Cerro Gordo
4 45
4 46
4 47
4 48 MARTIN of Scott
4 49
4 50
5 1
5 2 BRAUNS of Muscatine
5 3
5 4
5 5
5 6 HOUSER of Pottawattamie
5 7
5 8
5 9
5 10 RAYHONS of Hancock
5 11
5 12
5 13
5 14 CORMACK of Webster
5 15
5 16
5 17
5 18 NELSON of Marshall
5 19
5 20
5 21
5 22 BODDICKER of Cedar
5 23
5 24
5 25
5 26 DAVIS of Wapello
5 27
5 28
5 29
5 30 ARNOLD of Lucas
5 31
5 32
5 33
5 34 HEATON of Henry
5 35 SF 276.205 78
5 36 mj/gg
Text: H01166 Text: H01168 Text: H01100 - H01199 Text: H Index Bills and Amendments: General Index Bill History: General Index
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