Text: S05066                            Text: S05068
Text: S05000 - S05099                   Text: S Index
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Senate Amendment 5067

Amendment Text

PAG LIN
  1  1    Amend Senate File 2336 as follows:
  1  2    #1.  Page 12, by inserting after line 14 the
  1  3 following:  
  1  4                      "DIVISION    
  1  5                   MANAGED HEALTH CARE
  1  6    Sec.    .  NEW SECTION.  514L.1  LIABILITY OF A
  1  7 MANAGED CARE HEALTH PLAN OR HEALTH MAINTENANCE
  1  8 ORGANIZATION.
  1  9    1.  For purposes of this section, unless the
  1 10 context otherwise requires:
  1 11    a.  "Managed care health plan" means a health
  1 12 benefit plan that selects and contracts with health
  1 13 care providers; manages and coordinates health care
  1 14 delivery; monitors necessity, appropriateness, and
  1 15 quality of health care delivered by health care
  1 16 providers; and performs utilization review and cost
  1 17 control.
  1 18    b.  "Health maintenance organization" means a
  1 19 health maintenance organization as defined in section
  1 20 514B.1, subsection 6.
  1 21    2.  a.  A managed care health plan or health
  1 22 maintenance organization shall exercise ordinary care
  1 23 when making health care treatment decisions and is
  1 24 liable for damages for harm to an insured or enrollee
  1 25 proximately caused by its failure to exercise ordinary
  1 26 care.  An insured or enrollee may bring an action
  1 27 against a managed care health plan or health
  1 28 maintenance organization for a breach of the duty to
  1 29 exercise ordinary care.
  1 30    For purposes of this section, a managed care health
  1 31 plan or health maintenance organization includes an
  1 32 employee, agent, or other person acting on behalf of
  1 33 the managed care health plan or health maintenance
  1 34 organization.
  1 35    b.  In any action brought under this section
  1 36 against a managed care health plan or health
  1 37 maintenance organization, the managed care health plan
  1 38 or health maintenance organization may assert as a
  1 39 defense either of the following:
  1 40    (1)  The managed care health plan or health
  1 41 maintenance organization did not control, influence,
  1 42 or participate in the health care treatment decision.
  1 43    (2)  The managed care health plan or health
  1 44 maintenance organization did not deny or delay payment
  1 45 for any treatment prescribed or recommended by a
  1 46 health care provider.
  1 47    c.  This section does not create a duty on the part
  1 48 of the managed care health plan or health maintenance
  1 49 organization to provide treatment which is not covered
  1 50 by the health care plan of the managed care health
  2  1 plan or health maintenance organization.
  2  2    d.  In an action against a managed care health plan
  2  3 or health maintenance organization, a finding that a
  2  4 physician or other health care provider is an
  2  5 employee, agent, or representative of such managed
  2  6 care health plan or health maintenance organization
  2  7 shall not be based solely on proof that such person's
  2  8 name appears in a listing of approved health care
  2  9 providers made available to insureds or enrollees." 
  2 10 
  2 11 
  2 12                               
  2 13 JOHNIE HAMMOND
  2 14 SF 2336.701 78
  2 15 da/cls
     

Text: S05066                            Text: S05068
Text: S05000 - S05099                   Text: S Index
Bills and Amendments: General Index     Bill History: General Index

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