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PAG LIN
1 1 SENATE FILE 276
1 2
1 3 AN ACT
1 4 RELATING TO HEALTH CARE SERVICE AND TREATMENT COVERAGE BY
1 5 PROVIDING FOR CONTINUITY OF CARE, DISCUSSION AND ADVOCACY
1 6 OF TREATMENT OPTIONS, COVERAGE OF EMERGENCY ROOM SERVICES,
1 7 UTILIZATION REVIEW REQUIREMENTS, AND AN EXTERNAL REVIEW
1 8 PROCESS, AND PROVIDING AN EFFECTIVE DATE.
1 9
1 10 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 11
1 12 Section 1. NEW SECTION. 514C.14 CONTINUITY OF CARE –
1 13 PREGNANCY.
1 14 1. Except as provided under subsection 2 or 3, a carrier,
1 15 as defined in section 513B.2, an organized delivery system,
1 16 authorized under 1993 Iowa Acts, chapter 158, or a plan
1 17 established pursuant to chapter 509A for public employees,
1 18 which terminates its contract with a participating health care
1 19 provider, shall continue to provide coverage under the
1 20 contract to a covered person in the second or third trimester
1 21 of pregnancy for continued care from such health care
1 22 provider. Such persons may continue to receive such treatment
1 23 or care through postpartum care related to the child birth and
1 24 delivery. Payment for covered benefits and benefit levels
1 25 shall be according to the terms and conditions of the
1 26 contract.
1 27 2. A covered person who makes an involuntary change in
1 28 health plans may request that the new health plan cover the
1 29 services of the covered person's physician specialist who is
1 30 not a participating health care provider under the new health
1 31 plan, if the covered person is in the second or third
1 32 trimester of pregnancy. Continuation of such coverage shall
1 33 continue through postpartum care related to the child birth
1 34 and delivery. Payment for covered benefits and benefit level
1 35 shall be according to the terms and conditions of the new
2 1 health plan contract.
2 2 3. A carrier, organized delivery system, or plan
2 3 established under chapter 509A, which terminates the contract
2 4 of a participating health care provider for cause shall not be
2 5 liable to pay for health care services provided by the health
2 6 care provider to a covered person following the date of
2 7 termination.
2 8 Sec. 2. NEW SECTION. 514C.15 TREATMENT OPTIONS.
2 9 A carrier, as defined in section 513B.2; an organized
2 10 delivery system authorized under 1993 Iowa Acts, chapter 158,
2 11 and licensed by the director of public health; or a plan
2 12 established pursuant to chapter 509A for public employees,
2 13 shall not prohibit a participating provider from, or penalize
2 14 a participating provider for, doing either of the following:
2 15 1. Discussing treatment options with a covered individual,
2 16 notwithstanding the carrier's, organized delivery system's, or
2 17 plan's position on such treatment option.
2 18 2. Advocating on behalf of a covered individual within a
2 19 review or grievance process established by the carrier,
2 20 organized delivery system, or chapter 509A plan, or
2 21 established by a person contracting with the carrier,
2 22 organized delivery system, or chapter 509A plan.
2 23 Sec. 3. NEW SECTION. 514C.16 EMERGENCY ROOM SERVICES.
2 24 1. A carrier, as defined in section 513B.2; an organized
2 25 delivery system authorized under 1993 Iowa Acts, chapter 158,
2 26 and licensed by the director of public health; or a plan
2 27 established pursuant to chapter 509A for public employees,
2 28 which provides coverage for emergency services, is responsible
2 29 for charges for emergency services provided to a covered
2 30 individual, including services furnished outside any
2 31 contractual provider network or preferred provider network.
2 32 Coverage for emergency services is subject to the terms and
2 33 conditions of the health benefit plan or contract.
2 34 2. Prior authorization for emergency services shall not be
2 35 required. All services necessary to evaluate and stabilize an
3 1 emergency medical condition shall be considered covered
3 2 emergency services.
3 3 3. For purposes of this section, unless the context
3 4 otherwise requires:
3 5 a. "Emergency medical condition" means a medical condition
3 6 that manifests itself by symptoms of sufficient severity,
3 7 including but not limited to severe pain, that an ordinarily
3 8 prudent person, possessing average knowledge of medicine and
3 9 health, could reasonably expect the absence of immediate
3 10 medical attention to result in one of the following:
3 11 (1) Placing the health of the individual, or with respect
3 12 to a pregnant woman, the health of the woman or her unborn
3 13 child, in serious jeopardy.
3 14 (2) Serious impairment to bodily function.
3 15 (3) Serious dysfunction of a bodily organ or part.
3 16 b. "Emergency services" means covered inpatient and
3 17 outpatient health care services that are furnished by a health
3 18 care provider who is qualified to provide the services that
3 19 are needed to evaluate or stabilize an emergency medical
3 20 condition.
3 21 Sec. 4. NEW SECTION. 514C.17 CONTINUITY OF CARE –
3 22 TERMINAL ILLNESS.
3 23 1. Except as provided under subsection 2 or 3, if a
3 24 carrier, as defined in section 513B.2, an organized delivery
3 25 system, authorized under 1993 Iowa Acts, chapter 158, or a
3 26 plan established pursuant to chapter 509A for public
3 27 employees, terminates its contract with a participating health
3 28 care provider, a covered individual who is undergoing a
3 29 specified course of treatment for a terminal illness or a
3 30 related condition, with the recommendation of the covered
3 31 individual's treating physician licensed under chapter 148,
3 32 150, or 150A, may continue to receive coverage for treatment
3 33 received from the covered individual's physician for the
3 34 terminal illness or a related condition, for a period of up to
3 35 ninety days. Payment for covered benefits and benefit level
4 1 shall be according to the terms and conditions of the
4 2 contract.
4 3 2. A covered person who makes a change in health plans
4 4 involuntarily may request that the new health plan cover
4 5 services of the covered person's treating physician licensed
4 6 under chapter 148, 150, or 150A, who is not a participating
4 7 health care provider under the new health plan, if the covered
4 8 person is undergoing a specified course of treatment for a
4 9 terminal illness or a related condition. Continuation of such
4 10 coverage shall continue for up to ninety days. Payment for
4 11 covered benefits and benefit levels shall be according to the
4 12 terms and conditions of the contract.
4 13 3. Notwithstanding subsections 1 and 2, a carrier,
4 14 organized delivery system, or plan established under chapter
4 15 509A which terminates the contract of a participating health
4 16 care provider for cause shall not be required to cover health
4 17 care services provided by the health care provider to a
4 18 covered person following the date of termination.
4 19 Sec. 5. NEW SECTION. 514F.4 UTILIZATION REVIEW
4 20 REQUIREMENTS.
4 21 1. A third-party payor which provides health benefits to a
4 22 covered individual residing in this state shall not conduct
4 23 utilization review, either directly or indirectly, under a
4 24 contract with a third-party who does not meet the requirements
4 25 established for accreditation by the utilization review
4 26 accreditation commission, national committee on quality
4 27 assurance, or another national accreditation entity recognized
4 28 and approved by the commissioner.
4 29 2. This section does not apply to any utilization review
4 30 performed solely under contract with the federal government
4 31 for review of patients eligible for services under any of the
4 32 following:
4 33 a. Title XVIII of the federal Social Security Act.
4 34 b. The civilian health and medical program of the
4 35 uniformed services.
5 1 c. Any other federal employee health benefit plan.
5 2 3. For purposes of this section, unless the context
5 3 otherwise requires:
5 4 a. "Third-party payor" means:
5 5 (1) An insurer subject to chapter 509 or 514A.
5 6 (2) A health service corporation subject to chapter 514.
5 7 (3) A health maintenance organization subject to chapter
5 8 514B.
5 9 (4) A preferred provider arrangement.
5 10 (5) A multiple employer welfare arrangement.
5 11 (6) A third-party administrator.
5 12 (7) A fraternal benefit society.
5 13 (8) A plan established pursuant to chapter 509A for public
5 14 employees.
5 15 (9) Any other benefit program providing payment,
5 16 reimbursement, or indemnification for health care costs for an
5 17 enrollee or an enrollee's eligible dependents.
5 18 b. "Utilization review" means a program or process by
5 19 which an evaluation is made of the necessity, appropriateness,
5 20 and efficiency of the use of health care services, procedures,
5 21 or facilities given or proposed to be given to an individual
5 22 within this state. Such evaluation does not apply to requests
5 23 by an individual or provider for a clarification, guarantee,
5 24 or statement of an individual's health insurance coverage or
5 25 benefits provided under a health insurance policy, nor to
5 26 claims adjudication. Unless it is specifically stated,
5 27 verification of benefits, preauthorization, or a prospective
5 28 or concurrent utilization review program or process shall not
5 29 be construed as a guarantee or statement of insurance coverage
5 30 or benefits for any individual under a health insurance
5 31 policy.
5 32 Sec. 6. NEW SECTION. 514F.5 EXPERIMENTAL TREATMENT
5 33 REVIEW.
5 34 1. A carrier, as defined in section 513B.2, an organized
5 35 delivery system, authorized under 1993 Iowa Acts, chapter 158,
6 1 or a plan established pursuant to chapter 509A for public
6 2 employees, that limits coverage for experimental medical
6 3 treatment, drugs, or devices, shall develop and implement a
6 4 procedure to evaluate experimental medical treatments and
6 5 shall submit a description of the procedure to the division of
6 6 insurance. The procedure shall be in writing and must
6 7 describe the process used to determine whether the carrier,
6 8 organized delivery system, or chapter 509A plan will provide
6 9 coverage for new medical technologies and new uses of existing
6 10 technologies. The procedure, at a minimum, shall require a
6 11 review of information from appropriate government regulatory
6 12 agencies and published scientific literature concerning new
6 13 medical technologies, new uses of existing technologies, and
6 14 the use of external experts in making decisions. A carrier,
6 15 organized delivery system, or chapter 509A plan shall include
6 16 appropriately licensed or qualified professionals in the
6 17 evaluation process. The procedure shall provide a process for
6 18 a person covered under a plan or contract to request a review
6 19 of a denial of coverage because the proposed treatment is
6 20 experimental. A review of a particular treatment need not be
6 21 reviewed more than once a year.
6 22 2. A carrier, organized delivery system, or chapter 509A
6 23 plan that limits coverage for experimental treatment, drugs,
6 24 or devices shall clearly disclose such limitations in a
6 25 contract, policy, or certificate of coverage.
6 26 Sec. 7. NEW SECTION. 514J.1 LEGISLATIVE INTENT.
6 27 It is the intent of the general assembly to provide a
6 28 mechanism for the appeal of a denial of coverage based on
6 29 medical necessity.
6 30 Sec. 8. NEW SECTION. 514J.2 DEFINITIONS.
6 31 1. "Carrier" means an entity subject to the insurance laws
6 32 and regulations of this state, or subject to the jurisdiction
6 33 of the commissioner, performing utilization review, including
6 34 an insurance company offering sickness and accident plans, a
6 35 health maintenance organization, a nonprofit health service
7 1 corporation, a plan established pursuant to chapter 509A for
7 2 public employees, or any other entity providing a plan of
7 3 health insurance, health care benefits, or health care
7 4 services.
7 5 2. "Commissioner" means the commissioner of insurance.
7 6 3. "Coverage decision" means a final adverse decision
7 7 based on medical necessity. This definition does not include
7 8 a denial of coverage for a service or treatment specifically
7 9 listed in plan or evidence of coverage documents as excluded
7 10 from coverage.
7 11 4. "Enrollee" means an individual, or an eligible
7 12 dependent, who receives health care benefits coverage through
7 13 a carrier or organized delivery system.
7 14 5. "Independent review entity" means a reviewer or entity,
7 15 certified by the commissioner pursuant to section 514J.6.
7 16 6. "Organized delivery system" means an organized delivery
7 17 system authorized under 1993 Iowa Acts, chapter 158, and
7 18 licensed by the director of public health, and performing
7 19 utilization review.
7 20 Sec. 9. NEW SECTION. 514J.3 EXCLUSIONS.
7 21 This chapter does not apply to a hospital confinement
7 22 indemnity, credit, dental, vision, long-term care, disability
7 23 income insurance coverage, coverage issued as a supplement to
7 24 liability insurance, workers compensation or similar
7 25 insurance, or automobile medical payment insurance.
7 26 Sec. 10. NEW SECTION. 514J.4 EXTERNAL REVIEW REQUEST.
7 27 1. At the time of a coverage decision, the carrier or
7 28 organized delivery system shall notify the enrollee in writing
7 29 of the right to have the coverage decision reviewed under the
7 30 external review process.
7 31 2. The enrollee, or the enrollee's treating health care
7 32 provider acting on behalf of the enrollee, may file a written
7 33 request for external review of the coverage decision with the
7 34 commissioner. The request must be filed within sixty days of
7 35 the receipt of the coverage decision. However, the enrollee's
8 1 treating health care provider does not have a duty to request
8 2 external review.
8 3 3. The request for external review must be accompanied by
8 4 a twenty-five dollar filing fee. The commissioner may waive
8 5 the filing fee for good cause. The filing fee shall be
8 6 refunded if the enrollee prevails in the external review
8 7 process.
8 8 Sec. 11. NEW SECTION. 514J.5 ELIGIBILITY.
8 9 1. The commissioner shall have two business days from
8 10 receipt of a request for an external review to certify the
8 11 request. The commissioner shall certify the request if the
8 12 following criteria are satisfied:
8 13 a. The enrollee was covered by the carrier or organized
8 14 delivery system at the time the service or treatment was
8 15 proposed.
8 16 b. The enrollee has been denied coverage based on a
8 17 determination by the carrier or organized delivery system that
8 18 the proposed service or treatment does not meet the definition
8 19 of medical necessity as defined in the enrollee's evidence of
8 20 coverage.
8 21 c. The enrollee, or the enrollee's treating health care
8 22 provider acting on behalf of the enrollee, has exhausted all
8 23 internal appeal mechanisms provided under the carrier's or the
8 24 organized delivery system's contract.
8 25 d. The written request for external review was filed
8 26 within sixty days of receipt of the coverage decision.
8 27 2. The commissioner shall notify the enrollee, or the
8 28 enrollee's treating health care provider acting on behalf of
8 29 the enrollee, and the carrier or organized delivery system in
8 30 writing of the decision.
8 31 3. The carrier or organized delivery system has three
8 32 business days to contest the eligibility of the request for
8 33 external review with the commissioner. If the commissioner
8 34 finds that the request for external review is not eligible for
8 35 full review, the commissioner, within two business days, shall
9 1 notify the enrollee, or the enrollee's treating health care
9 2 provider acting on behalf of the enrollee, in writing of the
9 3 reasons that the request for external review is not eligible
9 4 for full review.
9 5 Sec. 12. NEW SECTION. 514J.6 INDEPENDENT REVIEW
9 6 ENTITIES.
9 7 1. The commissioner shall solicit names of independent
9 8 review entities from carriers, organized delivery systems, and
9 9 medical and health care professional associations.
9 10 2. Independent review entities include, but are not
9 11 limited to, the following:
9 12 a. Medical peer review organizations.
9 13 b. Nationally recognized health experts or institutions.
9 14 3. The commissioner shall certify independent review
9 15 entities to conduct external reviews. An individual who
9 16 conducts an external review as or as part of a certified
9 17 independent review entity shall be a health care professional
9 18 and satisfy both of the following requirements:
9 19 a. Hold a current unrestricted license to practice
9 20 medicine or a health profession in the United States. A
9 21 health care professional who is a physician shall also hold a
9 22 current certification by a recognized American medical
9 23 specialty board. A health care professional who is not a
9 24 physician shall also hold a current certification by such
9 25 professional's respective specialty board.
9 26 b. Have no history of disciplinary actions or sanctions,
9 27 including, but not limited to, the loss of staff privileges or
9 28 any participation restriction taken or pending by any hospital
9 29 or state or federal government regulatory agency.
9 30 4. Each independent review entity shall have a quality
9 31 assurance program on file with the commissioner that ensures
9 32 the timeliness and quality of the reviews, the qualifications
9 33 and independence of the experts, and the confidentiality of
9 34 medical records and review materials.
9 35 5. The commissioner shall certify independent review
10 1 entities every two years.
10 2 Sec. 13. NEW SECTION. 514J.7 EXTERNAL REVIEW.
10 3 The external review process shall meet the following
10 4 criteria:
10 5 1. The carrier or organized delivery system, within three
10 6 business days of a receipt of an eligible request for an
10 7 external review from the commissioner, shall do all of the
10 8 following:
10 9 a. Select an independent review entity from the list
10 10 certified by the commissioner. The independent review entity
10 11 shall be an expert in the treatment of the medical condition
10 12 under review. The independent review entity shall not be a
10 13 subsidiary of, or owned or controlled by the carrier or
10 14 organized delivery system, or owned or controlled by a trade
10 15 association of carriers or organized delivery systems of which
10 16 the carrier or organized delivery system is a member.
10 17 b. Notify the enrollee, and the enrollee's treating health
10 18 care provider, of the name, address, and phone number of the
10 19 independent review entity and of the enrollee's and treating
10 20 health care provider's right to submit additional information.
10 21 The enrollee, or the enrollee's treating health care provider
10 22 acting on behalf of the enrollee, may object to the
10 23 independent review entity selected by the carrier or organized
10 24 delivery system by notifying the commissioner within three
10 25 business days of the receipt of notice from the carrier or
10 26 organized delivery system. The commissioner shall have two
10 27 business days from receipt of the objection to consider the
10 28 reasons set forth in support of the objection, to select an
10 29 independent review entity, and to provide the notice required
10 30 by this subsection to the enrollee, the enrollee's treating
10 31 health care provider, and the carrier or organized delivery
10 32 system.
10 33 c. Provide any information submitted to the carrier or
10 34 organized delivery system by the enrollee or the enrollee's
10 35 treating health care provider in support of the request for
11 1 coverage of a service or treatment under the carrier's or
11 2 organized delivery system's appeal procedures.
11 3 d. Provide any other relevant documents used by the
11 4 carrier or organized delivery system in determining whether
11 5 the proposed service or treatment should have been provided.
11 6 2. The enrollee, or the enrollee's treating health care
11 7 provider, may provide any information submitted in support of
11 8 the internal review, and other newly discovered relevant
11 9 information. The enrollee shall have ten business days from
11 10 the mailing date of the final notification of the independent
11 11 review entity's selection to provide this information.
11 12 Failure to provide the information within ten days shall be
11 13 ground for rejection of consideration of the information by
11 14 the independent review entity.
11 15 3. The independent review entity shall notify the enrollee
11 16 and the enrollee's treating health care provider of any
11 17 additional medical information required to conduct the review
11 18 within five business days of receipt of the documentation
11 19 required under subsection 1. The requested information shall
11 20 be submitted within five days. Failure to provide the
11 21 information shall be ground for rejection of consideration of
11 22 the information by the independent review entity. The carrier
11 23 or organized delivery system shall be notified of this
11 24 request.
11 25 4. The independent review entity shall submit its decision
11 26 as soon as possible, but not more than thirty days from the
11 27 independent review entity's receipt of the request for review.
11 28 The decision shall be mailed to the enrollee, or the treating
11 29 health care provider acting on behalf of the enrollee, and the
11 30 carrier or organized delivery system.
11 31 5. The confidentiality of any medical records submitted
11 32 shall be maintained pursuant to applicable state and federal
11 33 laws.
11 34 Sec. 14. NEW SECTION. 514J.8 EXPEDITED REVIEW.
11 35 An expedited review shall be conducted within seventy-two
12 1 hours of notification to the commissioner if the enrollee's
12 2 treating health care provider states that delay would pose an
12 3 imminent or serious threat to the enrollee.
12 4 Sec. 15. NEW SECTION. 514J.9 FUNDING.
12 5 All reasonable fees and costs of the independent review
12 6 entity in conducting an external review shall be paid by the
12 7 carrier or organized delivery system.
12 8 Sec. 16. NEW SECTION. 514J.10 REPORTING.
12 9 Each carrier and organized delivery system shall file an
12 10 annual report with the commissioner containing all of the
12 11 following:
12 12 1. The number of external reviews requested.
12 13 2. The number of the external reviews certified by the
12 14 commissioner.
12 15 3. The number of coverage decisions which were upheld by
12 16 an independent review entity.
12 17 The commissioner shall prepare a report by January 31 of
12 18 each year.
12 19 Sec. 17. NEW SECTION. 514J.11 IMMUNITY.
12 20 An independent review entity conducting a review under this
12 21 chapter is not liable for damages arising from determinations
12 22 made under the review process. This does not apply to any act
12 23 or omission by the independent review entity made in bad faith
12 24 or involving gross negligence.
12 25 Sec. 18. NEW SECTION. 514J.12 STANDARD OF REVIEW.
12 26 Review by the independent review entity is de novo. The
12 27 standard of review to be used by an independent review entity
12 28 shall be whether the health care service or treatment denied
12 29 by the carrier or organized delivery system was medically
12 30 necessary as defined by the enrollee's evidence of coverage
12 31 subject to Iowa law and consistent with clinical standards of
12 32 medical practice. The independent review entity shall take
12 33 into consideration factors identified in the review record
12 34 that impact the delivery of or describe the standard of care
12 35 for the medical service or treatment under review. The
13 1 medical service or treatment recommended by the enrollee's
13 2 treating health care provider shall be upheld upon review so
13 3 long as it is found to be medically necessary and consistent
13 4 with clinical standards of medical practice.
13 5 Sec. 19. NEW SECTION. 514J.13 EFFECT OF EXTERNAL REVIEW
13 6 DECISION.
13 7 The review decision by the independent review entity
13 8 conducting the review is binding upon the carrier or organized
13 9 delivery system. The enrollee or the enrollee's treating
13 10 health care provider acting on behalf of the enrollee may
13 11 appeal the review decision by the independent review entity
13 12 conducting the review by filing a petition for judicial review
13 13 either in Polk county district court or in the district court
13 14 in the county in which the enrollee resides. The petition for
13 15 judicial review must be filed within fifteen business days
13 16 after the issuance of the review decision. The findings of
13 17 fact by the independent review entity conducting the review
13 18 are conclusive and binding on appeal. The carrier or
13 19 organized delivery system shall follow and comply with the
13 20 review decision of the independent review entity conducting
13 21 the review, or the decision of the court on appeal. The
13 22 carrier or organized delivery system and the enrollee's
13 23 treating health care provider shall not be subject to any
13 24 penalties, sanctions, or award of damages for following and
13 25 complying in good faith with the review decision of the
13 26 independent review entity conducting the review or decision of
13 27 the court on appeal. The enrollee or the enrollee's treating
13 28 health care provider may bring an action in Polk county
13 29 district court or in the district court in the county in which
13 30 the enrollee resides to enforce the review decision of the
13 31 independent review entity conducting the review or the
13 32 decision of the court on appeal.
13 33 Sec. 20. NEW SECTION. 514J.14 RULES.
13 34 The commissioner shall adopt rules pursuant to chapter 17A
13 35 as are necessary to administer this chapter.
14 1 Sec. 21. NEW SECTION. 514K.1 HEALTH CARE PLAN
14 2 DISCLOSURES – INFORMATION TO ENROLLEES.
14 3 1. A health maintenance organization, an organized
14 4 delivery system, or an insurer using a preferred provider
14 5 arrangement shall provide to each of its enrollees at the time
14 6 of enrollment, and shall make available to each prospective
14 7 enrollee upon request, written information as required by
14 8 rules adopted by the commissioner and the director of public
14 9 health. The information required by rule shall include, but
14 10 not be limited to, all of the following:
14 11 a. A description of the plan's benefits and exclusions.
14 12 b. Enrollee cost-sharing requirements.
14 13 c. A list of participating providers.
14 14 d. Disclosure of the existence of any drug formularies
14 15 used and, upon request, information about the specific drugs
14 16 included in the formulary.
14 17 e. An explanation for accessing emergency care services.
14 18 f. Any policies addressing investigational or experimental
14 19 treatments.
14 20 g. The methodologies used to compensate providers.
14 21 h. Performance measures as determined by the commissioner
14 22 and the director.
14 23 i. Information on how to access internal and external
14 24 grievance procedures.
14 25 2. The commissioner and the director shall annually
14 26 publish a consumer guide providing a comparison by plan on
14 27 performance measures, network composition, and other key
14 28 information to enable consumers to better understand plan
14 29 differences.
14 30 Sec. 22. EFFECTIVE DATE. Sections 7 through 20 of this
14 31 Act, which create new chapter 514J, take effect January 1,
14 32 2000.
14 33
14 34
14 35
15 1 MARY E. KRAMER
15 2 President of the Senate
15 3
15 4
15 5
15 6 RON J. CORBETT
15 7 Speaker of the House
15 8
15 9 I hereby certify that this bill originated in the Senate and
15 10 is known as Senate File 276, Seventy-eighth General Assembly.
15 11
15 12
15 13
15 14 MICHAEL E. MARSHALL
15 15 Secretary of the Senate
15 16 Approved , 1999
15 17
15 18
15 19
15 20 THOMAS J. VILSACK
15 21 Governor
Text: SF00275 Text: SF00277 Text: SF00200 - SF00299 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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