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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