Text: HF00091 Text: HF00093 Text: HF00000 - HF00099 Text: HF 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 2003, 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 care or treatment 2 8 provided by a chiropractor shall be compensated at the same 2 9 level as equivalent services provided by a person licensed in 2 10 the practice of medicine and surgery under chapter 148 or 2 11 150A. The policy shall provide that the policyholder may 2 12 reject the coverage or provision if the coverage or provision 2 13 for diagnosis or treatment of a human ailment by a 2 14 chiropractor is rejected for all providers of diagnosis or 2 15 treatment for similar human ailments licensed under chapter 2 16 148, 150, 150A, or 151. A policy of group health insurance 2 17 may limit or make optional the payment or reimbursement for 2 18 lawful diagnostic or treatment service by all licensees under 2 19 chapters 148, 150, 150A, and 151 on any rational basis which 2 20 is not solely related to the license under or the practices 2 21 authorized by chapter 151 or is not dependent upon a method of 2 22 classification, categorization, or description based directly 2 23 or indirectly upon differences in terminology used by 2 24 different licensees in describing human ailments or their 2 25 diagnosis or treatment. This subsection applies to group 2 26 policies delivered or issued for delivery after July 1, 1986, 2 27 and to existing group policies on their next anniversary or 2 28 renewal date, or upon expiration of the applicable collective 2 29 bargaining contract, if any, whichever is later. This 2 30 subsection does not apply to blanket, short-term travel, 2 31 accident-only, limited or specified disease, or individual or 2 32 group conversion policies, or policies under Title XVIII of 2 33 the Social Security Act, or any other similar coverage under a 2 34 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 care or treatment provided by registered nurses shall be 3 12 compensated at the same level as equivalent services provided 3 13 by a person licensed in the practice of medicine and surgery 3 14 under chapter 148 or 150A. This subsection shall not require 3 15 payment for nursing services provided by a certified nurse 3 16 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 2003, is amended by adding the 3 33 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 a 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 2003, 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 509.3, unnumbered paragraph 1, Code 2003, 4 29 is amended to read as follows: 4 30 In addition to the provisions required in subsections 1 4 31 through78, the commissioner shall require provisions through 4 32 the adoption of rules implementing the federal Health 4 33 Insurance Portability and Accountability Act, Pub. L. No. 104- 4 34 191. 4 35 Sec. 4. Section 514B.1, subsection 5, paragraphs b, c, and 5 1 d, Code 2003, are amended to read as follows: 5 2 b. The health care services available to enrollees under 5 3 prepaid group plans covering vision care services or 5 4 procedures, shall include a provision for payment of necessary 5 5 medical or surgical care and treatment provided by an 5 6 optometrist licensed under chapter 154, if performed within 5 7 the scope of the optometrist's license, and the plan would pay 5 8 for the care and treatment when the care and treatment were 5 9 provided by a person engaged in the practice of medicine or 5 10 surgery as licensed under chapter 148 or 150A. Additionally, 5 11 any optometric medical or surgical care and treatment provided 5 12 shall be compensated at the same level as equivalent services 5 13 provided by a person licensed in the practice of medicine or 5 14 surgery under chapter 148 or 150A. The plan shall provide 5 15 that the plan enrollees may reject the coverage for services 5 16 which may be provided by an optometrist if the coverage is 5 17 rejected for all providers of similar vision care services as 5 18 licensed under chapter 148, 150A, or 154. This paragraph 5 19 applies to services provided under plans made after July 1, 5 20 1983, and to existing group plans on their next anniversary or 5 21 renewal date, or upon the expiration of the applicable 5 22 collective bargaining contract, if any, whichever is the 5 23 later. This paragraph does not apply to enrollees eligible 5 24 for coverage under Title XVIII of the Social Security Act or 5 25 any other similar coverage under a state or federal government 5 26 plan. 5 27 c. The health care services available to enrollees under 5 28 prepaid group plans covering diagnosis and treatment of human 5 29 ailments, shall include a provision for payment of necessary 5 30 diagnosis or treatment provided by a chiropractor licensed 5 31 under chapter 151 if the diagnosis or treatment is provided 5 32 within the scope of the chiropractor's license and if the plan 5 33 would pay or reimburse for the diagnosis or treatment of human 5 34 ailment, irrespective of and disregarding variances in 5 35 terminology employed by the various licensed professions in 6 1 describing the human ailment or its diagnosis or its 6 2 treatment, if it were provided by a person licensed under 6 3 chapter 148, 150, or 150A. Additionally, any diagnosis and 6 4 treatment provided by a chiropractor shall be compensated at 6 5 the same level as equivalent services provided by a person 6 6 licensed in the practice of medicine or surgery under chapter 6 7 148 or 150A. The plan shall also provide that the plan 6 8 enrollees may reject the coverage for diagnosis or treatment 6 9 of a human ailment by a chiropractor if the coverage is 6 10 rejected for all providers of diagnosis or treatment for 6 11 similar human ailments licensed under chapter 148, 150, 150A, 6 12 or 151. A prepaid group plan of health care services may 6 13 limit or make optional the payment or reimbursement for lawful 6 14 diagnostic or treatment service by all licensees under 6 15 chapters 148, 150, 150A, and 151 on any rational basis which 6 16 is not solely related to the license under or the practices 6 17 authorized by chapter 151 or is not dependent upon a method of 6 18 classification, categorization, or description based upon 6 19 differences in terminology used by different licensees in 6 20 describing human ailments or their diagnosis or treatment. 6 21 This paragraph applies to services provided under plans made 6 22 after July 1, 1986, and to existing group plans on their next 6 23 anniversary or renewal date, or upon the expiration of the 6 24 applicable collective bargaining contract, if any, whichever 6 25 is the later. This paragraph does not apply to enrollees 6 26 eligible for coverage under Title XVIII of the Social Security 6 27 Act, or any other similar coverage under a state or federal 6 28 government plan. 6 29 d. The health care services available to enrollees under 6 30 prepaid group plans covering hospital, medical, or surgical 6 31 expenses, may include, at the option of the employer 6 32 purchaser, a provision for payment of covered services 6 33 determined to be medically necessary provided by a certified 6 34 registered nurse certified by a national certifying 6 35 organization, which organization shall be identified by the 7 1 Iowa board of nursing pursuant to rules adopted by the board, 7 2 if the services are within the practice of the profession of a 7 3 registered nurse as that practice is defined in section 152.1, 7 4 under terms and conditions agreed upon between the employer 7 5 purchaser and the health maintenance organization, subject to 7 6 utilization controls. Additionally, any covered services 7 7 provided by a registered nurse shall be compensated at the 7 8 same level as equivalent services provided by a person 7 9 licensed in the practice of medicine or surgery under chapter 7 10 148 or 150A. This paragraph shall not require payment for 7 11 nursing services provided by a certified registered nurse 7 12 practicing in a hospital, nursing facility, health care 7 13 institution, a physician's office, or other noninstitutional 7 14 setting if the certified registered nurse is an employee of 7 15 the hospital, nursing facility, health care institution, 7 16 physician, or other health care facility or health care 7 17 provider. This paragraph applies to services provided under 7 18 plans within this state made on or after July 1, 1989, and to 7 19 existing group plans on their next anniversary or renewal 7 20 date, or upon the expiration of the applicable collective 7 21 bargaining contract, if any, whichever is later. This 7 22 paragraph does not apply to enrollees eligible for coverage 7 23 under an individual contract or coverage designed only for 7 24 issuance to enrollees eligible for coverage under Title XVIII 7 25 of the federal Social Security Act, or under coverage which is 7 26 rated on a community basis, or any other similar coverage 7 27 under a state or federal government plan. 7 28 Sec. 5. Section 514B.1, subsection 5, Code 2003, is 7 29 amended by adding the following new paragraph: 7 30 NEW PARAGRAPH. e. The health care services available to 7 31 enrollees under prepaid group plans covering hospital, 7 32 medical, or surgical expenses shall include a provision for 7 33 payment of necessary medical or surgical care and treatment as 7 34 well as drug prescriptions provided by a podiatric physician 7 35 licensed under chapter 149, if performed within the scope of 8 1 the podiatrist's license and the plan would pay for the care 8 2 and treatment when the care and treatment were provided by a 8 3 person engaged in the practice of medicine or surgery as 8 4 licensed under chapter 148 or 150A. Additionally, any medical 8 5 or surgical service provided by a podiatrist shall be 8 6 compensated at the same level as equivalent services provided 8 7 by a person licensed in the practice of medicine or surgery 8 8 under chapter 148, 149, or 150A. The plan shall provide that 8 9 the plan enrollees may reject the coverage for services which 8 10 may be provided by a podiatric physician if the coverage is 8 11 rejected for all providers of similar services as licensed 8 12 under chapter 148, 149, or 150A. This paragraph applies to 8 13 services provided under plans made on or after July 1, 2003, 8 14 and to existing group plans on their next anniversary or 8 15 renewal date, or upon the expiration of the applicable 8 16 collective bargaining contract, if any, whichever is the 8 17 later. This paragraph does not apply to enrollees eligible 8 18 for coverage under Title XVIII of the federal Social Security 8 19 Act or any other similar coverage under a state or federal 8 20 government plan. 8 21 EXPLANATION 8 22 This bill establishes the requirement under group insurance 8 23 policies and health maintenance organization contracts that 8 24 treatment or services provided by a person licensed under Code 8 25 chapter 154 (optometrist), a person licensed under Code 8 26 chapter 151 (chiropractor), a person licensed under Code 8 27 chapter 152 (nursing), or a person licensed under Code chapter 8 28 149 (podiatrist), are to be compensated at the same level as 8 29 if the treatment or services were provided by a person 8 30 licensed under Code chapter 148 or 150A (allopathic and 8 31 osteopathic physicians). 8 32 The bill establishes provisions under group insurance 8 33 policies and health maintenance organization contracts to 8 34 require that if the policy or available health care services 8 35 currently cover or include care and treatment, as well as drug 9 1 prescriptions, if provided by a person licensed to practice 9 2 medicine and surgery under Code chapter 148 or a person 9 3 licensed to practice osteopathic medicine and surgery under 9 4 Code chapter 150A, the plan or health care services available 9 5 shall also allow for provision of the care and treatment, as 9 6 well as drug prescriptions, by a podiatric physician. The 9 7 bill also requires that the care or treatment be within the 9 8 scope of practice of the podiatric physician. This 9 9 requirement applies to policies delivered and issued and 9 10 services provided under plans on or after July 1, 2003, and to 9 11 existing plans on the latter of the anniversary, renewal, or 9 12 expiration of a collective bargaining contract. 9 13 LSB 1798HH 80 9 14 pf/pj/5
Text: HF00091 Text: HF00093 Text: HF00000 - HF00099 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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