Text: SSB03026 Text: SSB03028 Text: SSB03000 - SSB03099 Text: SSB Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. Section 509.3, subsections 5, 6, and 7, Code
1 2 Supplement 1999, are amended to read as follows:
1 3 5. A provision shall be made available to policyholders,
1 4 under group policies covering vision care services or
1 5 procedures, for payment of necessary medical or surgical care
1 6 and treatment provided by an optometrist licensed under
1 7 chapter 154 if the care and treatment are provided within the
1 8 scope of the optometrist's license and if the policy would pay
1 9 for the care and treatment if the care and treatment were
1 10 provided by a person engaged in the practice of medicine or
1 11 surgery as licensed under chapter 148 or 150A. The provision
1 12 shall also guarantee that any care or treatment provided by an
1 13 optometrist shall be compensated at the same level as
1 14 equivalent services provided by a person licensed in the
1 15 practice of medicine and surgery under chapter 148 or 150A.
1 16 The policy shall provide that the policyholder may reject the
1 17 coverage or provision if the coverage or provision for
1 18 services which may be provided by an optometrist is rejected
1 19 for all providers of similar vision care services as licensed
1 20 under chapter 148, 150A, or 154. This subsection applies to
1 21 group policies delivered or issued for delivery after July 1,
1 22 1983, and to existing group policies on their next anniversary
1 23 or renewal date, or upon expiration of the applicable
1 24 collective bargaining contract, if any, whichever is later.
1 25 This subsection does not apply to blanket, short-term travel,
1 26 accident only, limited or specified disease, or individual or
1 27 group conversion policies, or policies designed only for
1 28 issuance to persons for coverage under Title XVIII of the
1 29 Social Security Act, or any other similar coverage under a
1 30 state or federal government plan.
1 31 6. A provision shall be made available to policyholders
1 32 under group policies covering diagnosis and treatment of human
1 33 ailments for payment or reimbursement for necessary diagnosis
1 34 or treatment provided by a chiropractor licensed under chapter
1 35 151, if the diagnosis or treatment is provided within the
2 1 scope of the chiropractor's license and if the policy would
2 2 pay or reimburse for the diagnosis or treatment by a person
2 3 licensed under chapter 148, 150, or 150A of the human ailment,
2 4 irrespective of and disregarding variances in terminology
2 5 employed by the various licensed professions in describing the
2 6 human ailment or its diagnosis or its treatment. The
2 7 provision shall also guarantee that any diagnosis and
2 8 treatment provided by a chiropractor shall be compensated at
2 9 the same level as equivalent diagnosis and treatment provided
2 10 by a person licensed in the practice of medicine and surgery
2 11 under chapter 148 or 150A. The policy shall provide that the
2 12 policyholder may reject the coverage or provision if the
2 13 coverage or provision for diagnosis or treatment of a human
2 14 ailment by a chiropractor is rejected for all providers of
2 15 diagnosis or treatment for similar human ailments licensed
2 16 under chapter 148, 150, 150A, or 151. A policy of group
2 17 health insurance may limit or make optional the payment or
2 18 reimbursement for lawful diagnostic or treatment service by
2 19 all licensees under chapters 148, 150, 150A, and 151 on any
2 20 rational basis which is not solely related to the license
2 21 under or the practices authorized by chapter 151 or is not
2 22 dependent upon a method of classification, categorization, or
2 23 description based directly or indirectly upon differences in
2 24 terminology used by different licensees in describing human
2 25 ailments or their diagnosis or treatment. This subsection
2 26 applies to group policies delivered or issued for delivery
2 27 after July 1, 1986, and to existing group policies on their
2 28 next anniversary or renewal date, or upon expiration of the
2 29 applicable collective bargaining contract, if any, whichever
2 30 is later. This subsection does not apply to blanket, short-
2 31 term travel, accident-only, limited or specified disease, or
2 32 individual or group conversion policies, or policies under
2 33 Title XVIII of the Social Security Act, or any other similar
2 34 coverage under a state or federal government plan.
2 35 7. A provision shall be made available to policyholders,
3 1 under group policies covering hospital, medical, or surgical
3 2 expenses, for payment of covered services determined to be
3 3 medically necessary provided by registered nurses certified by
3 4 a national certifying organization, which organization shall
3 5 be identified by the Iowa board of nursing pursuant to rules
3 6 adopted by the board, if the services are within the practice
3 7 of the profession of a registered nurse as that practice is
3 8 defined in section 152.1, under terms and conditions agreed
3 9 upon between the insurer and the policyholder, subject to
3 10 utilization controls. The provision shall also guarantee that
3 11 any covered services provided by registered nurses shall be
3 12 compensated at the same level as equivalent covered services
3 13 provided by a person licensed in the practice of medicine and
3 14 surgery under chapter 148 or 150A. This subsection shall not
3 15 require payment for nursing services provided by a certified
3 16 nurse practicing in a hospital, nursing facility, health care
3 17 institution, physician's office, or other noninstitutional
3 18 setting if the certified nurse is an employee of the hospital,
3 19 nursing facility, health care institution, physician, or other
3 20 health care facility or health care provider. This subsection
3 21 applies to group policies delivered or issued for delivery in
3 22 this state on or after July 1, 1989, and to existing group
3 23 policies on their next anniversary or renewal dates, or upon
3 24 expiration of the applicable collective bargaining contract,
3 25 if any, whichever is later. This subsection does not apply to
3 26 blanket, short-term travel, accident only, limited or
3 27 specified disease, or individual or group conversion policies,
3 28 policies rated on a community basis, or policies designed only
3 29 for issuance to persons for eligible coverage under Title
3 30 XVIII of the federal Social Security Act, or any other similar
3 31 coverage under a state or federal government plan.
3 32 Sec. 2. Section 509.3, Code Supplement 1999, is amended by
3 33 adding the following new subsection:
3 34 NEW SUBSECTION. 8. A provision shall be made available to
3 35 policyholders, under group policies covering hospital,
4 1 medical, or surgical expenses for payment of necessary medical
4 2 or surgical care and treatment, as well as drug prescriptions,
4 3 provided by a person licensed to practice podiatry under
4 4 chapter 149, if the care and treatment are provided within the
4 5 scope of the person's license and if the policy would pay for
4 6 the care and treatment if the care and treatment were provided
4 7 by a person engaged in the practice of medicine and surgery as
4 8 licensed under chapter 148 or 150A. The provision shall also
4 9 guarantee that any medical or surgical services provided by a
4 10 podiatrist shall be compensated at the same level as
4 11 equivalent services provided by ar person licensed in the
4 12 practice of medicine or surgery under chapter 148 or 150A.
4 13 The policy shall provide that the policyholder may reject the
4 14 coverage or provision if the coverage or provision for similar
4 15 services which may be provided by a podiatric physician is
4 16 rejected for all providers of services as licensed under
4 17 chapter 148, 149, or 150A. This subsection applies to group
4 18 policies delivered or issued for delivery on or after July 1,
4 19 2000, and to existing group policies on their next anniversary
4 20 or renewal date, or upon expiration of the applicable
4 21 collective bargaining contract, if any, whichever is later.
4 22 This subsection does not apply to blanket, short-term travel,
4 23 accident only, limited or specified disease, or individual or
4 24 group conversion policies, or policies designed only for
4 25 issuance to persons for coverage under Title XVIII of the
4 26 federal Social Security Act, or any other similar coverage
4 27 under a state or federal government plan.
4 28 Sec. 3. Section 514B.1, subsection 5, paragraphs b, c, and
4 29 d, Code Supplement 1999, are amended to read as follows:
4 30 b. The health care services available to enrollees under
4 31 prepaid group plans covering vision care services or
4 32 procedures, shall include a provision for payment of necessary
4 33 medical or surgical care and treatment provided by an
4 34 optometrist licensed under chapter 154, if performed within
4 35 the scope of the optometrist's license, and the plan would pay
5 1 for the care and treatment when the care and treatment were
5 2 provided by a person engaged in the practice of medicine or
5 3 surgery as licensed under chapter 148 or 150A. Additionally,
5 4 any optometric medical or surgical care and treatment provided
5 5 shall be compensated at the same level as equivalent services
5 6 provided by a person licensed in the practice of medicine or
5 7 surgery under chapter 148 or 150A. The plan shall provide
5 8 that the plan enrollees may reject the coverage for services
5 9 which may be provided by an optometrist if the coverage is
5 10 rejected for all providers of similar vision care services as
5 11 licensed under chapter 148, 150A, or 154. This paragraph
5 12 applies to services provided under plans made after July 1,
5 13 1983, and to existing group plans on their next anniversary or
5 14 renewal date, or upon the expiration of the applicable
5 15 collective bargaining contract, if any, whichever is the
5 16 later. This paragraph does not apply to enrollees eligible
5 17 for coverage under Title XVIII of the Social Security Act or
5 18 any other similar coverage under a state or federal government
5 19 plan.
5 20 c. The health care services available to enrollees under
5 21 prepaid group plans covering diagnosis and treatment of human
5 22 ailments, shall include a provision for payment of necessary
5 23 diagnosis or treatment provided by a chiropractor licensed
5 24 under chapter 151 if the diagnosis or treatment is provided
5 25 within the scope of the chiropractor's license and if the plan
5 26 would pay or reimburse for the diagnosis or treatment of human
5 27 ailment, irrespective of and disregarding variances in
5 28 terminology employed by the various licensed professions in
5 29 describing the human ailment or its diagnosis or its
5 30 treatment, if it were provided by a person licensed under
5 31 chapter 148, 150, or 150A. Additionally, any diagnosis and
5 32 treatment provided by a chiropractor shall be compensated at
5 33 the same level as equivalent diagnosis and treatment provided
5 34 by a person licensed in the practice of medicine or surgery
5 35 under chapter 148 or 150A. The plan shall also provide that
6 1 the plan enrollees may reject the coverage for diagnosis or
6 2 treatment of a human ailment by a chiropractor if the coverage
6 3 is rejected for all providers of diagnosis or treatment for
6 4 similar human ailments licensed under chapter 148, 150, 150A,
6 5 or 151. A prepaid group plan of health care services may
6 6 limit or make optional the payment or reimbursement for lawful
6 7 diagnostic or treatment service by all licensees under
6 8 chapters 148, 150, 150A, and 151 on any rational basis which
6 9 is not solely related to the license under or the practices
6 10 authorized by chapter 151 or is not dependent upon a method of
6 11 classification, categorization, or description based upon
6 12 differences in terminology used by different licensees in
6 13 describing human ailments or their diagnosis or treatment.
6 14 This paragraph applies to services provided under plans made
6 15 after July 1, 1986, and to existing group plans on their next
6 16 anniversary or renewal date, or upon the expiration of the
6 17 applicable collective bargaining contract, if any, whichever
6 18 is the later. This paragraph does not apply to enrollees
6 19 eligible for coverage under Title XVIII of the Social Security
6 20 Act, or any other similar coverage under a state or federal
6 21 government plan.
6 22 d. The health care services available to enrollees under
6 23 prepaid group plans covering hospital, medical, or surgical
6 24 expenses, may include, at the option of the employer
6 25 purchaser, a provision for payment of covered services
6 26 determined to be medically necessary provided by a certified
6 27 registered nurse certified by a national certifying
6 28 organization, which organization shall be identified by the
6 29 Iowa board of nursing pursuant to rules adopted by the board,
6 30 if the services are within the practice of the profession of a
6 31 registered nurse as that practice is defined in section 152.1,
6 32 under terms and conditions agreed upon between the employer
6 33 purchaser and the health maintenance organization, subject to
6 34 utilization controls. This paragraph shall not require
6 35 payment for nursing services provided by a certified
7 1 registered nurse practicing in a hospital, nursing facility,
7 2 health care institution, a physician's office, or other
7 3 noninstitutional setting if the certified registered nurse is
7 4 an employee of the hospital, nursing facility, health care
7 5 institution, physician, or other health care facility or
7 6 health care provider. Additionally, any covered services
7 7 provided by a registered nurse shall be compensated at the
7 8 same level as equivalent covered services provided by a person
7 9 licensed in the practice of medicine or surgery under chapter
7 10 148 or 150A. This paragraph applies to services provided
7 11 under plans within this state made on or after July 1, 1989,
7 12 and to existing group plans on their next anniversary or
7 13 renewal date, or upon the expiration of the applicable
7 14 collective bargaining contract, if any, whichever is later.
7 15 This paragraph does not apply to enrollees eligible for
7 16 coverage under an individual contract or coverage designed
7 17 only for issuance to enrollees eligible for coverage under
7 18 Title XVIII of the federal Social Security Act, or under
7 19 coverage which is rated on a community basis, or any other
7 20 similar coverage under a state or federal government plan.
7 21 Sec. 4. Section 514B.1, subsection 5, Code Supplement
7 22 1999, is amended by adding the following new paragraph:
7 23 NEW PARAGRAPH. e. The health care services available to
7 24 enrollees under prepaid group plans covering hospital,
7 25 medical, or surgical expenses shall include a provision for
7 26 payment of necessary medical or surgical care and treatment as
7 27 well as drug prescriptions provided by a podiatric physician
7 28 licensed under chapter 149, if performed within the scope of
7 29 the podiatrist's license and the plan would pay for the care
7 30 and treatment when the care and treatment were provided by a
7 31 person engaged in the practice of medicine or surgery as
7 32 licensed under chapter 148 or 150A. Additionally, any medical
7 33 or surgical service provided by a podiatrist shall be
7 34 compensated at the same level as equivalent services provided
7 35 by a person licensed in the practice of medicine or surgery
8 1 under chapter 148, 149, or 150A. The plan shall provide that
8 2 the plan enrollees may reject the coverage for services which
8 3 may be provided by a podiatric physician if the coverage is
8 4 rejected for all providers of similar services as licensed
8 5 under chapter 148, 149, or 150A. This paragraph applies to
8 6 services provided under plans made on or after July 1, 2000,
8 7 and to existing group plans on their next anniversary or
8 8 renewal date, or upon the expiration of the applicable
8 9 collective bargaining contract, if any, whichever is the
8 10 later. This paragraph does not apply to enrollees eligible
8 11 for coverage under Title XVIII of the federal Social Security
8 12 Act or any other similar coverage under a state or federal
8 13 government plan.
8 14 EXPLANATION
8 15 This bill establishes the requirement under group insurance
8 16 policies and health maintenance organization contracts that
8 17 treatment or services provided by a person licensed under Code
8 18 chapter 154 (optometrist), a person licensed under Code
8 19 chapter 151 (chiropractor), a person licensed under Code
8 20 chapter 152 (nursing), or a person licensed under Code chapter
8 21 149 (podiatrist), are to be compensated at the same level as
8 22 if the treatment or services were provided by a person
8 23 licensed under Code chapter 148 or 150A (allopathic and
8 24 osteopathic physicians).
8 25 The bill establishes provisions under group insurance
8 26 policies and health maintenance organization contracts to
8 27 require that if the policy or available health care services
8 28 currently cover or include care and treatment, as well as drug
8 29 prescriptions, if provided by a person licensed to practice
8 30 medicine and surgery under Code chapter 148 or a person
8 31 licensed to practice osteopathic medicine and surgery under
8 32 Code chapter 150A, the plan or health care services available
8 33 shall also allow for provision of the care and treatment, as
8 34 well as drug prescriptions, by a podiatric physician. The
8 35 bill also requires that the care or treatment be within the
9 1 scope of practice of the podiatric physician. This
9 2 requirement applies to policies delivered and issued and
9 3 services provided under plans on or after July 1, 2000, and to
9 4 existing plans on the latter of the anniversary, renewal, or
9 5 expiration of a collective bargaining contract.
9 6 LSB 5901SC 78
9 7 pf/cf/24
Text: SSB03026 Text: SSB03028 Text: SSB03000 - SSB03099 Text: SSB Index Bills and Amendments: General Index Bill History: General Index
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