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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