Text: HF02461 Text: HF02463 Text: HF02400 - HF02499 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. NEW SECTION. 514C.21 ENTERAL FORMULAS 1 2 COVERAGE. 1 3 1. Notwithstanding the uniformity of treatment 1 4 requirements of section 514C.6, a group policy or contract 1 5 providing for third-party payment or prepayment of health or 1 6 medical expenses shall not exclude or restrict benefits for 1 7 enteral formulas for home use for which a practitioner 1 8 licensed by law to prescribe and administer prescription drugs 1 9 has issued a written order, if such policy or contract 1 10 provides benefits for other outpatient prescription drugs or 1 11 devices. Such written order shall state that the enteral 1 12 formula is medically necessary for the patient. 1 13 2. For purposes of this section, "enteral formula" means 1 14 enteral formulas which have been proven effective for the 1 15 treatment of specific diseases including, but not limited to, 1 16 inherited diseases of amino acid or organic acid metabolism; 1 17 Crohn's disease; gastroesophageal reflux with failure to 1 18 thrive; disorders of gastrointestinal motility such as chronic 1 19 intestinal pseudo-obstruction; and multiple, severe food 1 20 allergies, which if left untreated will cause malnourishment, 1 21 chronic physical disability, mental retardation, or death. 1 22 The commissioner, by rule, shall further define enteral 1 23 formula. 1 24 3. a. This section applies to the following classes of 1 25 third-party payment provider contracts or policies delivered, 1 26 issued for delivery, continued, or renewed in this state on or 1 27 after July 1, 2002: 1 28 (1) Individual or group accident and sickness insurance 1 29 providing coverage on an expense-incurred basis. 1 30 (2) Any individual or group hospital or medical service 1 31 contract issued pursuant to chapter 509, 514, or 514A. 1 32 (3) Any individual or group health maintenance 1 33 organization contract regulated under chapter 514B. 1 34 (4) Any other entity engaged in the business of insurance, 1 35 risk transfer, or risk retention, which is subject to the 2 1 jurisdiction of the commissioner. 2 2 (5) A plan established pursuant to chapter 509A for public 2 3 employees. 2 4 (6) An organized delivery system licensed by the director 2 5 of public health. 2 6 b. This section shall not apply to accident only, 2 7 specified disease, short-term hospital or medical, hospital 2 8 confinement indemnity, credit, dental, vision, Medicare 2 9 supplement, long-term care, basis hospital and medical- 2 10 surgical expense coverage as defined by the commissioner, 2 11 disability income insurance coverage, coverage issued as a 2 12 supplement to liability insurance, workers' compensation or 2 13 similar insurance, or automobile medical payment insurance. 2 14 EXPLANATION 2 15 This bill creates new Code section 514C.21 and provides 2 16 that a group policy or contract providing for third-party 2 17 payment or prepayment of health or medical expenses which 2 18 provides coverage benefits for other outpatient prescription 2 19 drugs or devices shall not exclude or restrict coverage 2 20 benefits for enteral formulas for home use prescribed by a 2 21 practitioner as being medically necessary and proven effective 2 22 as a disease-specific treatment regimen for individuals who 2 23 are or will become malnourished or suffer from disorders, 2 24 which, if left untreated, will cause chronic physical 2 25 disability, mental retardation, or death. 2 26 The bill defines "enteral formula" as formulas which have 2 27 been proven effective for the treatment of specific diseases 2 28 including, but not limited to, inherited diseases of amino 2 29 acid or organic acid metabolism; Crohn's disease; 2 30 gastroesophageal reflux with failure to thrive; disorders of 2 31 gastrointestinal motility such as chronic intestinal pseudo- 2 32 obstruction; and multiple, severe food allergies which if left 2 33 untreated will cause malnourishment, chronic physical 2 34 disability, mental retardation, or death. 2 35 The bill provides that the commissioner, by rule, shall 3 1 further define enteral formulas. The bill provides that the 3 2 new Code section applies to third-party payment provider 3 3 contracts, or policies delivered, issued for delivery, 3 4 continued, or renewed in this state on or after July 1, 2002. 3 5 LSB 5051YH 79 3 6 av/hk/91
Text: HF02461 Text: HF02463 Text: HF02400 - HF02499 Text: HF Index Bills and Amendments: General Index Bill History: General Index
© 2002 Cornell College and League of Women Voters of Iowa
Comments about this site or page?
webmaster@legis.iowa.gov.
Please remember that the person listed above does not vote on bills. Direct all comments concerning legislation to State Legislators.
Last update: Thu Feb 28 03:35:27 CST 2002
URL: /DOCS/GA/79GA/Legislation/HF/02400/HF02462/020220.html
jhf