Text: HF02189 Text: HF02191 Text: HF02100 - HF02199 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. Section 514F.2, Code 2003, is amended to read
1 2 as follows:
1 3 514F.2 UTILIZATION AND COST CONTROL.
1 4 1. Nothing contained in the chapters of Title XIII,
1 5 subtitle 1, of the Code shall be construed to prohibit or
1 6 discourage insurers, nonprofit service corporations, health
1 7 maintenance organizations, or self-insurers for health care
1 8 benefits to employees from providing payments of benefits or
1 9 providing care and treatment under capitated payment systems,
1 10 prospective reimbursement rate systems, utilization control
1 11 systems, incentive systems for the use of least restrictive
1 12 and least costly levels of care, preferred provider contracts
1 13 limiting choice of specific provider, or other systems,
1 14 methods or organizations designed to contain costs without
1 15 sacrificing care or treatment outcome, provided these systems
1 16 do not limit or make optional payment or reimbursement for
1 17 health care services on a basis solely related to the license
1 18 under or the practices authorized by chapter 151 or on a basis
1 19 that is dependent upon a method of classification,
1 20 categorization, or description based upon differences in
1 21 terminology used by different licensees under the chapters of
1 22 Title IV, subtitle 3, of the Code in describing human ailments
1 23 or their diagnosis or treatment.
1 24 2. Notwithstanding subsection 1, an insurer, nonprofit
1 25 service corporation, health maintenance organization, or self-
1 26 insurer for health care benefits to employees shall not
1 27 discriminate against any provider who is located within the
1 28 geographic coverage area of the plan and who is willing to
1 29 meet the terms and conditions for participation established by
1 30 the insurer, nonprofit service corporation, health maintenance
1 31 organization, or self-insurer for health care benefits.
1 32 EXPLANATION
1 33 This bill provides that an insurer, nonprofit service
1 34 corporation, health maintenance organization, or self-insurer
1 35 for health care benefits to employees shall not be permitted
2 1 to discriminate against any provider who is located within the
2 2 geographic coverage area of the plan and who is willing to
2 3 meet the terms and conditions for participation established by
2 4 the specified insurer or organization. This provision would
2 5 constitute a limitation on the provisions of Code section
2 6 514F.2 regarding cost control measures undertaken by insurers
2 7 or organizations that involved limiting the number of
2 8 qualified health care providers with whom the insurer or
2 9 organization contracted for participation in the plan.
2 10 LSB 5397HH 80
2 11 rn/gg/14
Text: HF02189 Text: HF02191 Text: HF02100 - HF02199 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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