Text: S03052 Text: S03054 Text: S03000 - S03099 Text: S Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend Senate File 276 as follows:
1 2 #1. Page 3, by inserting after line 10 the
1 3 following:
1 4 "Sec. . NEW SECTION. 514C.17 CONTINUITY OF
1 5 CARE – TERMINAL ILLNESS.
1 6 1. Except as provided under subsection 2 or 3, if
1 7 a carrier, as defined in section 513B.2, an organized
1 8 delivery system, authorized under 1993 Iowa Acts,
1 9 chapter 158, or a plan established pursuant to chapter
1 10 509A for public employees, terminates its contract
1 11 with a participating health care provider, a covered
1 12 individual who is undergoing a specified course of
1 13 treatment for a terminal illness or a related
1 14 condition, with the recommendation of the covered
1 15 individual's treating physician licensed under chapter
1 16 148, 150, or 150A, may continue to receive coverage
1 17 for treatment received from the covered individual's
1 18 physician for the terminal illness or a related
1 19 condition, for a period of up to ninety days. Payment
1 20 for covered benefits and benefit level shall be
1 21 according to the terms and conditions of the contract.
1 22 2. A covered person who makes a change in health
1 23 plans involuntarily may request that the new health
1 24 plan cover services of the covered person's treating
1 25 physician licensed under chapter 148, 150, or 150A,
1 26 who is not a participating health care provider under
1 27 the new health plan, if the covered person is
1 28 undergoing a specified course of treatment for a
1 29 terminal illness or a related condition. Continuation
1 30 of such coverage shall continue for up to ninety days.
1 31 Payment for covered benefits and benefit levels shall
1 32 be according to the terms and conditions of the
1 33 contract.
1 34 3. Notwithstanding subsections 1 and 2, a carrier,
1 35 organized delivery system, or plan established under
1 36 chapter 509A which terminates the contract of a
1 37 participating health care provider for cause shall not
1 38 be required to cover health care services provided by
1 39 the health care provider to a covered person following
1 40 the date of termination."
1 41 #2. Page 4, by inserting after line 23 the
1 42 following:
1 43 "Sec. . NEW SECTION. 514F.5 EXPERIMENTAL
1 44 TREATMENT REVIEW.
1 45 1. A carrier, as defined in section 513B.2, an
1 46 organized delivery system, authorized under 1993 Iowa
1 47 Acts, chapter 158, or a plan established pursuant to
1 48 chapter 509A for public employees, that limits
1 49 coverage for experimental medical treatment, drugs, or
1 50 devices, shall develop and implement a procedure to
2 1 evaluate experimental medical treatments and shall
2 2 submit a description of the procedure to the division
2 3 of insurance. The procedure shall be in writing and
2 4 must describe the process used to determine whether
2 5 the carrier, organized delivery system, or chapter
2 6 509A plan will provide coverage for new medical
2 7 technologies and new uses of existing technologies.
2 8 The procedure, at a minimum, shall require a review of
2 9 information from appropriate government regulatory
2 10 agencies and published scientific literature
2 11 concerning new medical technologies, new uses of
2 12 existing technologies, and the use of external experts
2 13 in making decisions. A carrier, organized delivery
2 14 system, or chapter 509A plan shall include
2 15 appropriately licensed or qualified professionals in
2 16 the evaluation process. The procedure shall provide a
2 17 process for a person covered under a plan or contract
2 18 to request a review of a denial of coverage because
2 19 the proposed treatment is experimental. A review of a
2 20 particular treatment need not be reviewed more than
2 21 once a year.
2 22 2. A carrier, organized delivery system, or
2 23 chapter 509A plan that limits coverage for
2 24 experimental treatment, drugs, or devices shall
2 25 clearly disclose such limitations in a contract,
2 26 policy, or certificate of coverage."
2 27 #3. By renumbering as necessary.
2 28
2 29
2 30
2 31 JOHN REDWINE
2 32 SF 276.202 78
2 33 mj/gg
Text: S03052 Text: S03054 Text: S03000 - S03099 Text: S Index Bills and Amendments: General Index Bill History: General Index
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