Text: HF02143 Text: HF02145 Text: HF02100 - HF02199 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. Section 509.3, subsections 5 and 6, Code 1 2 Supplement 1999, are amended to read as follows: 1 3 5. A provision shall be made available to policyholders, 1 4 under group policies covering vision care services or 1 5 procedures, for payment of necessary medical or surgical care 1 6 and treatment provided by an optometrist licensed under 1 7 chapter 154 if the care and treatment are provided within the 1 8 scope of the optometrist's license and if the policy would pay 1 9 for the care and treatment if the care and treatment were 1 10 provided by a person engaged in the practice of medicine or 1 11 surgery as licensed under chapter 148 or 150A. The provision 1 12 shall also guarantee that any care or treatment provided by an 1 13 optometrist shall be compensated at the same level as 1 14 equivalent services provided by a person licensed in the 1 15 practice of medicine and surgery under chapter 148 or 150A. 1 16 The policy shall provide that the policyholder may reject the 1 17 coverage or provision if the coverage or provision for 1 18 services which may be provided by an optometrist is rejected 1 19 for all providers of similar vision care services as licensed 1 20 under chapter 148, 150A, or 154. This subsection applies to 1 21 group policies delivered or issued for delivery after July 1, 1 22 1983, and to existing group policies on their next anniversary 1 23 or renewal date, or upon expiration of the applicable 1 24 collective bargaining contract, if any, whichever is later. 1 25 This subsection does not apply to blanket, short-term travel, 1 26 accident only, limited or specified disease, or individual or 1 27 group conversion policies, or policies designed only for 1 28 issuance to persons for coverage under Title XVIII of the 1 29 Social Security Act, or any other similar coverage under a 1 30 state or federal government plan. 1 31 6. A provision shall be made available to policyholders 1 32 under group policies covering diagnosis and treatment of human 1 33 ailments for payment or reimbursement for necessary diagnosis 1 34 or treatment provided by a chiropractor licensed under chapter 1 35 151, if the diagnosis or treatment is provided within the 2 1 scope of the chiropractor's license and if the policy would 2 2 pay or reimburse for the diagnosis or treatment by a person 2 3 licensed under chapter 148, 150, or 150A of the human ailment, 2 4 irrespective of and disregarding variances in terminology 2 5 employed by the various licensed professions in describing the 2 6 human ailment or its diagnosis or its treatment. The 2 7 provision shall also guarantee that any diagnosis and 2 8 treatment provided by a chiropractor shall be compensated at 2 9 the same level as equivalent diagnosis and treatment provided 2 10 by a person licensed in the practice of medicine and surgery 2 11 under chapter 148 or 150A. The policy shall provide that the 2 12 policyholder may reject the coverage or provision if the 2 13 coverage or provision for diagnosis or treatment of a human 2 14 ailment by a chiropractor is rejected for all providers of 2 15 diagnosis or treatment for similar human ailments licensed 2 16 under chapter 148, 150, 150A, or 151. A policy of group 2 17 health insurance may limit or make optional the payment or 2 18 reimbursement for lawful diagnostic or treatment service by 2 19 all licensees under chapters 148, 150, 150A, and 151 on any 2 20 rational basis which is not solely related to the license 2 21 under or the practices authorized by chapter 151 or is not 2 22 dependent upon a method of classification, categorization, or 2 23 description based directly or indirectly upon differences in 2 24 terminology used by different licensees in describing human 2 25 ailments or their diagnosis or treatment. This subsection 2 26 applies to group policies delivered or issued for delivery 2 27 after July 1, 1986, and to existing group policies on their 2 28 next anniversary or renewal date, or upon expiration of the 2 29 applicable collective bargaining contract, if any, whichever 2 30 is later. This subsection does not apply to blanket, short- 2 31 term travel, accident-only, limited or specified disease, or 2 32 individual or group conversion policies, or policies under 2 33 Title XVIII of the Social Security Act, or any other similar 2 34 coverage under a state or federal government plan. 2 35 Sec. 2. Section 509.3, Code Supplement 1999, is amended by 3 1 adding the following new subsection: 3 2 NEW SUBSECTION. 8. A provision shall be made available to 3 3 policyholders, under group policies covering hospital, 3 4 medical, or surgical expenses for payment of necessary medical 3 5 or surgical care and treatment, as well as drug prescriptions, 3 6 provided by a person licensed to practice podiatry under 3 7 chapter 149, if the care and treatment are provided within the 3 8 scope of the person's license and if the policy would pay for 3 9 the care and treatment if the care and treatment were provided 3 10 by a person engaged in the practice of medicine and surgery as 3 11 licensed under chapter 148 or 150A. The provision shall also 3 12 guarantee that any medical or surgical services provided by a 3 13 podiatrist shall be compensated at the same level as 3 14 equivalent services provided by ar person licensed in the 3 15 practice of medicine or surgery under chapter 148 or 150A. 3 16 The policy shall provide that the policyholder may reject the 3 17 coverage or provision if the coverage or provision for similar 3 18 services which may be provided by a podiatric physician is 3 19 rejected for all providers of services as licensed under 3 20 chapter 148, 149, or 150A. This subsection applies to group 3 21 policies delivered or issued for delivery on or after July 1, 3 22 2000, and to existing group policies on their next anniversary 3 23 or renewal date, or upon expiration of the applicable 3 24 collective bargaining contract, if any, whichever is later. 3 25 This subsection does not apply to blanket, short-term travel, 3 26 accident only, limited or specified disease, or individual or 3 27 group conversion policies, or policies designed only for 3 28 issuance to persons for coverage under Title XVIII of the 3 29 federal Social Security Act, or any other similar coverage 3 30 under a state or federal government plan. 3 31 Sec. 3. Section 514B.1, subsection 5, paragraphs b and c, 3 32 Code Supplement 1999, are amended to read as follows: 3 33 b. The health care services available to enrollees under 3 34 prepaid group plans covering vision care services or 3 35 procedures, shall include a provision for payment of necessary 4 1 medical or surgical care and treatment provided by an 4 2 optometrist licensed under chapter 154, if performed within 4 3 the scope of the optometrist's license, and the plan would pay 4 4 for the care and treatment when the care and treatment were 4 5 provided by a person engaged in the practice of medicine or 4 6 surgery as licensed under chapter 148 or 150A. Additionally, 4 7 any optometric medical or surgical care and treatment provided 4 8 shall be compensated at the same level as equivalent services 4 9 provided by a person licensed in the practice of medicine or 4 10 surgery under chapter 148 or 150A. The plan shall provide 4 11 that the plan enrollees may reject the coverage for services 4 12 which may be provided by an optometrist if the coverage is 4 13 rejected for all providers of similar vision care services as 4 14 licensed under chapter 148, 150A, or 154. This paragraph 4 15 applies to services provided under plans made after July 1, 4 16 1983, and to existing group plans on their next anniversary or 4 17 renewal date, or upon the expiration of the applicable 4 18 collective bargaining contract, if any, whichever is the 4 19 later. This paragraph does not apply to enrollees eligible 4 20 for coverage under Title XVIII of the Social Security Act or 4 21 any other similar coverage under a state or federal government 4 22 plan. 4 23 c. The health care services available to enrollees under 4 24 prepaid group plans covering diagnosis and treatment of human 4 25 ailments, shall include a provision for payment of necessary 4 26 diagnosis or treatment provided by a chiropractor licensed 4 27 under chapter 151 if the diagnosis or treatment is provided 4 28 within the scope of the chiropractor's license and if the plan 4 29 would pay or reimburse for the diagnosis or treatment of human 4 30 ailment, irrespective of and disregarding variances in 4 31 terminology employed by the various licensed professions in 4 32 describing the human ailment or its diagnosis or its 4 33 treatment, if it were provided by a person licensed under 4 34 chapter 148, 150, or 150A. Additionally, any diagnosis and 4 35 treatment provided by a chiropractor shall be compensated at 5 1 the same level as equivalent diagnosis and treatment provided 5 2 by a person licensed in the practice of medicine or surgery 5 3 under chapter 148 or 150A. The plan shall also provide that 5 4 the plan enrollees may reject the coverage for diagnosis or 5 5 treatment of a human ailment by a chiropractor if the coverage 5 6 is rejected for all providers of diagnosis or treatment for 5 7 similar human ailments licensed under chapter 148, 150, 150A, 5 8 or 151. A prepaid group plan of health care services may 5 9 limit or make optional the payment or reimbursement for lawful 5 10 diagnostic or treatment service by all licensees under 5 11 chapters 148, 150, 150A, and 151 on any rational basis which 5 12 is not solely related to the license under or the practices 5 13 authorized by chapter 151 or is not dependent upon a method of 5 14 classification, categorization, or description based upon 5 15 differences in terminology used by different licensees in 5 16 describing human ailments or their diagnosis or treatment. 5 17 This paragraph applies to services provided under plans made 5 18 after July 1, 1986, and to existing group plans on their next 5 19 anniversary or renewal date, or upon the expiration of the 5 20 applicable collective bargaining contract, if any, whichever 5 21 is the later. This paragraph does not apply to enrollees 5 22 eligible for coverage under Title XVIII of the Social Security 5 23 Act, or any other similar coverage under a state or federal 5 24 government plan. 5 25 Sec. 4. Section 514B.1, subsection 5, Code Supplement 5 26 1999, is amended by adding the following new paragraph: 5 27 NEW PARAGRAPH. e. The health care services available to 5 28 enrollees under prepaid group plans covering hospital, 5 29 medical, or surgical expenses shall include a provision for 5 30 payment of necessary medical or surgical care and treatment as 5 31 well as drug prescriptions provided by a podiatric physician 5 32 licensed under chapter 149, if performed within the scope of 5 33 the podiatrist's license and the plan would pay for the care 5 34 and treatment when the care and treatment were provided by a 5 35 person engaged in the practice of medicine or surgery as 6 1 licensed under chapter 148 or 150A. Additionally, any medical 6 2 or surgical service provided by a podiatrist shall be 6 3 compensated at the same level as equivalent services provided 6 4 by a person licensed in the practice of medicine or surgery 6 5 under chapter 148, 149, or 150A. The plan shall provide that 6 6 the plan enrollees may reject the coverage for services which 6 7 may be provided by a podiatric physician if the coverage is 6 8 rejected for all providers of similar services as licensed 6 9 under chapter 148, 149, or 150A. This paragraph applies to 6 10 services provided under plans made on or after July 1, 2000, 6 11 and to existing group plans on their next anniversary or 6 12 renewal date, or upon the expiration of the applicable 6 13 collective bargaining contract, if any, whichever is the 6 14 later. This paragraph does not apply to enrollees eligible 6 15 for coverage under Title XVIII of the federal Social Security 6 16 Act or any other similar coverage under a state or federal 6 17 government plan. 6 18 EXPLANATION 6 19 This bill establishes the requirement under group insurance 6 20 policies and health maintenance organization contracts that 6 21 treatment or services provided by a person licensed under Code 6 22 chapter 154 (optometrist), a person licensed under Code 6 23 chapter 151 (chiropractor), or a person licensed under Code 6 24 chapter 149 (podiatrist), are to be compensated at the same 6 25 level as if the treatment or services were provided by a 6 26 person licensed under Code chapter 148 or 150A (persons 6 27 licensed to practice medicine and surgery and persons licensed 6 28 to practice osteopathic medicine and surgery). 6 29 The bill establishes provisions under group insurance 6 30 policies and health maintenance organization contracts to 6 31 require that if the policy or available health care services 6 32 currently cover or include care and treatment, as well as drug 6 33 prescriptions, if provided by a person licensed to practice 6 34 medicine and surgery under Code chapter 148 or a person 6 35 licensed to practice osteopathic medicine and surgery under 7 1 Code chapter 150A, the plan or health care services available 7 2 shall also allow for provision of the care and treatment, as 7 3 well as drug prescriptions, by a podiatrist. The bill also 7 4 requires that the care or treatment be within the scope of 7 5 practice of the podiatrist. This requirement applies to 7 6 policies delivered and issued and services provided under 7 7 plans on or after July 1, 2000, and to existing plans on the 7 8 latter of the anniversary, renewal, or expiration of a 7 9 collective bargaining contract. 7 10 LSB 5901HH 78 7 11 pf/cf/24.1
Text: HF02143 Text: HF02145 Text: HF02100 - HF02199 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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