Text: HSB00658 Text: HSB00660 Text: HSB00600 - HSB00699 Text: HSB Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. Section 507B.4, Code Supplement 2001, is 1 2 amended by adding the following new subsections: 1 3 NEW SUBSECTION. 12A. PARTICIPATION CLAUSES. Requiring a 1 4 health care provider to participate in an insurer's benefit 1 5 programs, plans, or products as a condition of participating 1 6 in any of the insurer's other programs, plans, or products or 1 7 reducing a health care provider's payment for covered services 1 8 provided under a program, plan, or product because the health 1 9 care provider did not participate in any of the insurer's 1 10 other programs, plans, or products. It is not an unfair 1 11 practice under this subsection for an insurer to develop a 1 12 single contract with terms and conditions applicable to more 1 13 than one benefit program, plan, or product as long as the 1 14 health care provider is not required by that single contract 1 15 to participate in a program, plan, or product as a condition 1 16 of participation in any other program, plan, or product. 1 17 For purposes of this subsection, "insurer" means the same 1 18 as defined in subsection 12. "Health care provider" means the 1 19 same as defined in section 514C.13, subsection 1. 1 20 NEW SUBSECTION. 12B. PRICING RESTRICTIONS. Requiring a 1 21 health care provider providing covered services under a 1 22 benefit plan, program, or product of an insurer to accept as 1 23 payment for those covered services the lowest price, including 1 24 discounts and incentives charged by or paid to the health care 1 25 provider for the same services by any other person, as defined 1 26 in section 4.1. 1 27 For purposes of this subsection, "insurer" means the same 1 28 as defined in subsection 12. "Health care provider" means the 1 29 same as defined in section 514C.13, subsection 1. 1 30 NEW SUBSECTION. 12C. LACK OF SPECIFICITY IN CONTRACT 1 31 TERMS AND CONDITIONS. Failure of an insurer to clearly 1 32 specify in each agreement with a health care provider under 1 33 which a health care provider provides covered services, what 1 34 benefit plans, programs, or products the health care provider 1 35 has agreed to participate in pursuant to the agreement, and 2 1 the terms and conditions, including payment for each covered 2 2 service, applicable to each program, plan, or product included 2 3 under the agreement. An insurer must have and make available 2 4 to a health care provider a method or process that enables a 2 5 health care provider to determine the amount paid for each 2 6 covered service and that does not reduce or attempt to reduce 2 7 the amount paid to a health care provider for a covered 2 8 service by using an amount, discount, or payment reduction 2 9 formula or methodology that the insurer and health care 2 10 provider have not directly and specifically agreed upon as 2 11 applicable to the covered service in question. The 2 12 commissioner of insurance shall adopt rules pursuant to 2 13 chapter 17A to administer this subsection. 2 14 For purposes of this subsection, "insurer" means the same 2 15 as defined in subsection 12. "Health care provider" means the 2 16 same as defined in section 514C.13, subsection 1. 2 17 EXPLANATION 2 18 This bill amends Code section 507B.4 to designate certain 2 19 insurance practices related to health care providers as unfair 2 20 methods of competition and practice. The bill makes it an 2 21 unfair practice for an insurer to require a health care 2 22 provider to participate in an insurer's benefit programs, 2 23 plans, or products as a condition of participating in any of 2 24 the insurer's other programs, plans, or products or reducing a 2 25 health care provider's payment for covered services provided 2 26 under a program, plan, or product because the health care 2 27 provider did not participate in any of the insurer's other 2 28 programs, plans, or products. 2 29 The bill also makes it an unfair practice for an insurer to 2 30 require a health care provider providing covered services 2 31 under a benefit plan, program, or product to accept as payment 2 32 for those covered services the lowest price charged by or paid 2 33 to the health care provider for the same services by any other 2 34 person. 2 35 The bill also makes it an unfair practice to an insurer to 3 1 fail to clearly specify in each agreement with a health care 3 2 provider what plans, programs, or products the health care 3 3 provider has agreed to participate in pursuant to the 3 4 agreement and the terms and conditions, including payment for 3 5 each covered service, applicable to each program, plan, or 3 6 product included in the agreement. In addition, an insurer 3 7 must have and make available to a health care provider a 3 8 method or process that enables a health care provider to 3 9 determine the amount paid for each covered service and that 3 10 does not reduce the amount paid to a health care provider by 3 11 using a formula or methodology that the insurer and the health 3 12 care provider have not specifically agreed upon. The 3 13 commissioner of insurance is directed to adopt rules pursuant 3 14 to Code chapter 17A to administer this provision. 3 15 For purposes of the bill, an "insurer" means an entity 3 16 providing a plan of health insurance, health care benefits, or 3 17 health care services, or an entity performing utilization 3 18 review, including an insurance company offering sickness and 3 19 accident plans, a health maintenance organization, an 3 20 organized delivery system, a nonprofit health service 3 21 corporation, a plan established pursuant to Code chapter 509A 3 22 for public employees, or any other entity providing a plan of 3 23 health insurance, health care benefits, or health care 3 24 services. A "health care provider" means a hospital licensed 3 25 pursuant to Code chapter 135B, a person licensed under Code 3 26 chapter 148, 148C, 149, 150, 150A, 151, or 154, or a person 3 27 licensed as an advanced registered nurse practitioner under 3 28 Code chapter 152. 3 29 LSB 6656HC 79 3 30 av/sh/8
Text: HSB00658 Text: HSB00660 Text: HSB00600 - HSB00699 Text: HSB 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: Fri Feb 15 03:30:47 CST 2002
URL: /DOCS/GA/79GA/Legislation/HSB/00600/HSB00659/020214.html
jhf