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