Text: HF00197 Text: HF00199 Text: HF00100 - HF00199 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 514C.13A GROUP MANAGED CARE
1 2 HEALTH PLANS – PROHIBITION OF CERTAIN FINANCIAL INCENTIVES
1 3 FOR HEALTH CARE PROVIDERS.
1 4 1. A managed care health plan, as defined in section
1 5 514C.13, shall not contain any provision in a contract with
1 6 any health care provider, as defined in section 514C.13, that,
1 7 as its predominant purpose, creates direct financial
1 8 incentives for the health care provider to withhold medically
1 9 necessary, covered health care services.
1 10 2. This section shall not be construed to prohibit a
1 11 contract between a health care provider and a managed care
1 12 health plan that contains financial incentives for efficient
1 13 management of the utilization and cost of covered health care
1 14 services.
1 15 EXPLANATION
1 16 This bill creates new Code section 514C.13A, to prohibit
1 17 provisions in a contract between a managed care health plan
1 18 and a health care provider that have a predominant purpose of
1 19 creating direct financial incentives for the health care
1 20 provider to withhold medically necessary, covered health care
1 21 services.
1 22 The new Code section specifically states that the
1 23 prohibition against such clauses does not extend to financial
1 24 incentives for efficient management of the utilization and
1 25 cost of covered health care services.
1 26 LSB 2241HH 79
1 27 jj/cf/24
Text: HF00197 Text: HF00199 Text: HF00100 - HF00199 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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