Text: S05186 Text: S05188 Text: S05100 - S05199 Text: S Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend House File 2316, as passed by the House, as
1 2 follows:
1 3 #1. Page 1, by inserting before line 1 the
1 4 following:
1 5 "Section 1. NEW SECTION. 514L.1 LIABILITY OF A
1 6 MANAGED CARE HEALTH PLAN OR HEALTH MAINTENANCE
1 7 ORGANIZATION.
1 8 1. For purposes of this section, unless the
1 9 context otherwise requires:
1 10 a. "Managed care health plan" means a health
1 11 benefit plan that selects and contracts with health
1 12 care providers; manages and coordinates health care
1 13 delivery; monitors necessity, appropriateness, and
1 14 quality of health care delivered by health care
1 15 providers; and performs utilization review and cost
1 16 control.
1 17 b. "Health maintenance organization" means a
1 18 health maintenance organization as defined in section
1 19 514B.1, subsection 6.
1 20 2. a. A managed care health plan or health
1 21 maintenance organization shall exercise ordinary care
1 22 when making health care treatment decisions and is
1 23 liable for damages for harm to an insured or enrollee
1 24 proximately caused by its failure to exercise ordinary
1 25 care. An insured or enrollee may bring an action
1 26 against a managed care health plan or health
1 27 maintenance organization for a breach of the duty to
1 28 exercise ordinary care.
1 29 For purposes of this section, a managed care health
1 30 plan or health maintenance organization includes an
1 31 employee, agent, or other person acting on behalf of
1 32 the managed care health plan or health maintenance
1 33 organization.
1 34 b. In any action brought under this section
1 35 against a managed care health plan or health
1 36 maintenance organization, the managed care health plan
1 37 or health maintenance organization may assert as a
1 38 defense either of the following:
1 39 (1) The managed care health plan or health
1 40 maintenance organization did not control, influence,
1 41 or participate in the health care treatment decision.
1 42 (2) The managed care health plan or health
1 43 maintenance organization did not deny or delay payment
1 44 for any treatment prescribed or recommended by a
1 45 health care provider.
1 46 c. This section does not create a duty on the part
1 47 of the managed care health plan or health maintenance
1 48 organization to provide treatment which is not covered
1 49 by the health care plan of the managed care health
1 50 plan or health maintenance organization.
2 1 d. In an action against a managed care health plan
2 2 or health maintenance organization, a finding that a
2 3 physician or other health care provider is an
2 4 employee, agent, or representative of such managed
2 5 care health plan or health maintenance organization
2 6 shall not be based solely on proof that such person's
2 7 name appears in a listing of approved health care
2 8 providers made available to insureds or enrollees."
2 9 #2. By renumbering as necessary.
2 10
2 11
2 12
2 13 JOHNIE HAMMOND
2 14 HF 2316.201 78
2 15 mj/gg
Text: S05186 Text: S05188 Text: S05100 - S05199 Text: S Index Bills and Amendments: General Index Bill History: General Index
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