Text: HF02251 Text: HF02253 Text: HF02200 - HF02299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 514C.21 SPECIAL DIETARY USE
1 2 FOODS – COVERAGE.
1 3 1. DEFINITIONS. As used in this section, unless the
1 4 context otherwise requires:
1 5 a. "Designated medical condition" means any of the
1 6 following:
1 7 (1) A medical condition for which specific dietary
1 8 components or the restriction of specific dietary components
1 9 is necessary to treat a physical, physiological, or
1 10 pathological condition resulting in inadequate nutrition,
1 11 including but not limited to conditions of disease,
1 12 convalescence, pregnancy, lactation, allergic hypersensitivity
1 13 to food, prematurity, underweight, and overweight.
1 14 (2) An inherited metabolic disorder, including but not
1 15 limited to disorders of carbohydrate, lipid, vitamin, mineral,
1 16 amino acid, and nitrogen metabolism.
1 17 (3) A physical, physiological, or pathological impairment
1 18 of oral intake affecting growth.
1 19 b. "Special dietary use foods" means foods, including but
1 20 not limited to pasteurized donor breast milk, used to supply
1 21 particular dietary needs that exist because a person has a
1 22 designated medical condition. The commissioner, by rule,
1 23 shall further define special dietary use foods.
1 24 2. Notwithstanding the uniformity of treatment
1 25 requirements of section 514C.6, a group policy or contract
1 26 providing for third-party payment or prepayment of health or
1 27 medical expenses shall not exclude or restrict benefits for
1 28 the costs of and the costs associated with special dietary use
1 29 foods for home use for which a practitioner licensed by law to
1 30 prescribe and administer prescription drugs has issued a
1 31 written order, if such policy or contract provides benefits
1 32 for other outpatient prescription drugs or devices. Such
1 33 written order shall state that the special dietary use foods
1 34 ordered are medically necessary for the therapeutic treatment
1 35 of a designated medical condition and that the insured or
2 1 enrollee has such a designated medical condition.
2 2 3. Coverage benefits for the cost of and the costs
2 3 associated with special dietary use foods shall include all
2 4 aspects of the administration of such foods, including but not
2 5 limited to administration tubing, administration bags, pumps,
2 6 and patient management by licensed health care professionals
2 7 as necessary to administer or monitor the safe administration
2 8 of the special dietary use foods.
2 9 4. a. This section applies to the following classes of
2 10 third-party provider policies or contracts delivered, issued
2 11 for delivery, continued, or renewed in this state on or after
2 12 July 1, 2004:
2 13 (1) An individual or group accident and sickness insurance
2 14 policy or contract providing coverage on an expense-incurred
2 15 basis.
2 16 (2) An individual or group hospital or medical service
2 17 policy or contract issued pursuant to chapter 509, 514, or
2 18 514A.
2 19 (3) An individual or group health maintenance organization
2 20 policy or contract regulated under chapter 514B.
2 21 (4) Any other entity engaged in the business of insurance,
2 22 risk transfer, or risk retention, which is subject to the
2 23 jurisdiction of the commissioner.
2 24 (5) A plan established pursuant to chapter 509A for public
2 25 employees.
2 26 (6) An organized delivery system licensed by the director
2 27 of public health.
2 28 b. This section shall not apply to accident only,
2 29 specified disease, short-term hospital or medical, hospital
2 30 confinement indemnity, credit, dental, vision, Medicare
2 31 supplement, long-term care, basic hospital and medical-
2 32 surgical expense coverage as defined by the commissioner,
2 33 disability income insurance coverage, workers' compensation or
2 34 similar insurance, or automobile medical payment insurance.
2 35 EXPLANATION
3 1 This bill creates new Code section 514C.21 and provides
3 2 that a group policy or contract providing for third-party
3 3 payment of health or medical expenses that provides coverage
3 4 benefits for other outpatient prescription drugs or devices
3 5 shall not exclude or restrict benefits for the costs of and
3 6 the costs associated with special dietary use foods for home
3 7 use prescribed by a licensed practitioner as being medically
3 8 necessary for the therapeutic treatment of an insured or
3 9 enrollee who has a designated medical condition.
3 10 The bill defines "designated medical condition" as a
3 11 medical condition for which the use or restriction of specific
3 12 dietary components is necessary to treat a physical,
3 13 physiological, or pathological condition resulting in adequate
3 14 nutrition, including but not limited to conditions of disease,
3 15 convalescence, pregnancy, lactation, allergic hypersensitivity
3 16 to food, prematurity, underweight, and overweight; an
3 17 inherited metabolic disorder, including but not limited to
3 18 disorders of carbohydrate, lipid, vitamin, mineral, amino
3 19 acid, and nitrogen metabolism; and a physical, physiological,
3 20 or pathological impairment of oral intake affecting growth.
3 21 The bill defines "special dietary use foods" as foods,
3 22 including but not limited to pasteurized donor breast milk,
3 23 that are used to supply particular dietary needs that exist
3 24 because a person has a designated medical condition. The bill
3 25 also provides that the insurance commissioner, by rule, shall
3 26 further define special dietary use foods.
3 27 The bill provides that coverage benefits must include the
3 28 cost of special dietary use foods and the costs associated
3 29 with all aspects of the administration of such foods including
3 30 but not limited to administration tubing, administration bags,
3 31 pumps, and patient management by licensed health care
3 32 professionals as necessary to administer or monitor the safe
3 33 administration of the special dietary use foods.
3 34 The bill provides that the new Code section applies to
3 35 third-party payor policies or contracts delivered, issued for
4 1 delivery, continued, or renewed in this state on or after July
4 2 1, 2004, by an individual or group accident and sickness
4 3 insurance policy or contract; an individual or group hospital
4 4 or medical service policy or contract issued pursuant to Code
4 5 chapter 509, 514, or 514A; an individual or group health
4 6 maintenance organization policy or contract regulated under
4 7 Code chapter 514B; any other entity engaged in the business of
4 8 insurance, risk transfer, or risk retention that is subject to
4 9 the jurisdiction of the insurance commissioner; a plan
4 10 established pursuant to Code chapter 509A for public
4 11 employees; and an organized delivery system licensed by the
4 12 director of public health.
4 13 The new Code section does not apply to accident only,
4 14 specified disease, short-term hospital or medical, hospital
4 15 confinement indemnity, credit, dental, vision, Medicare
4 16 supplement, long-term care, basic hospital and medical-
4 17 surgical expense coverage as defined by the commissioner,
4 18 disability income insurance coverage, workers' compensation or
4 19 similar insurance, or automobile medical payment insurance.
4 20 LSB 5321YH 80
4 21 av/sh/8
Text: HF02251 Text: HF02253 Text: HF02200 - HF02299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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