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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