Text: S03275 Text: S03277 Text: S03200 - S03299 Text: S Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Amend House File 667, as amended, passed, and 1 2 reprinted by the House, as follows: 1 3 #1. Page 9, by inserting after line 15 the 1 4 following: 1 5 "Sec. . Section 509.3, subsections 5, 6, and 7, 1 6 Code 2003, are amended to read as follows: 1 7 5. A provision shall be made available to 1 8 policyholders, under group policies covering vision 1 9 care services or procedures, for payment of necessary 1 10 medical or surgical care and treatment provided by an 1 11 optometrist licensed under chapter 154 if the care and 1 12 treatment are provided within the scope of the 1 13 optometrist's license and if the policy would pay for 1 14 the care and treatment if the care and treatment were 1 15 provided by a person engaged in the practice of 1 16 medicine or surgery as licensed under chapter 148 or 1 17 150A. The provision shall also guarantee that any 1 18 care or treatment provided by an optometrist shall be 1 19 compensated at the same level as equivalent services 1 20 provided by a person licensed in the practice of 1 21 medicine and surgery under chapter 148 or 150A. The 1 22 policy shall provide that the policyholder may reject 1 23 the coverage or provision if the coverage or provision 1 24 for services which may be provided by an optometrist 1 25 is rejected for all providers of similar vision care 1 26 services as licensed under chapter 148, 150A, or 154. 1 27 This subsection applies to group policies delivered or 1 28 issued for delivery after July 1, 1983, and to 1 29 existing group policies on their next anniversary or 1 30 renewal date, or upon expiration of the applicable 1 31 collective bargaining contract, if any, whichever is 1 32 later. This subsection does not apply to blanket, 1 33 short-term travel, accident only, limited or specified 1 34 disease, or individual or group conversion policies, 1 35 or policies designed only for issuance to persons for 1 36 coverage under Title XVIII of the Social Security Act, 1 37 or any other similar coverage under a state or federal 1 38 government plan. 1 39 6. A provision shall be made available to 1 40 policyholders under group policies covering diagnosis 1 41 and treatment of human ailments for payment or 1 42 reimbursement for necessary diagnosis or treatment 1 43 provided by a chiropractor licensed under chapter 151, 1 44 if the diagnosis or treatment is provided within the 1 45 scope of the chiropractor's license and if the policy 1 46 would pay or reimburse for the diagnosis or treatment 1 47 by a person licensed under chapter 148, 150, or 150A 1 48 of the human ailment, irrespective of and disregarding 1 49 variances in terminology employed by the various 1 50 licensed professions in describing the human ailment 2 1 or its diagnosis or its treatment. The provision 2 2 shall also guarantee that any care or treatment 2 3 provided by a chiropractor shall be compensated at the 2 4 same level as equivalent services provided by a person 2 5 licensed in the practice of medicine and surgery under 2 6 chapter 148 or 150A. The policy shall provide that 2 7 the policyholder may reject the coverage or provision 2 8 if the coverage or provision for diagnosis or 2 9 treatment of a human ailment by a chiropractor is 2 10 rejected for all providers of diagnosis or treatment 2 11 for similar human ailments licensed under chapter 148, 2 12 150, 150A, or 151. A policy of group health insurance 2 13 may limit or make optional the payment or 2 14 reimbursement for lawful diagnostic or treatment 2 15 service by all licensees under chapters 148, 150, 2 16 150A, and 151 on any rational basis which is not 2 17 solely related to the license under or the practices 2 18 authorized by chapter 151 or is not dependent upon a 2 19 method of classification, categorization, or 2 20 description based directly or indirectly upon 2 21 differences in terminology used by different licensees 2 22 in describing human ailments or their diagnosis or 2 23 treatment. This subsection applies to group policies 2 24 delivered or issued for delivery after July 1, 1986, 2 25 and to existing group policies on their next 2 26 anniversary or renewal date, or upon expiration of the 2 27 applicable collective bargaining contract, if any, 2 28 whichever is later. This subsection does not apply to 2 29 blanket, short-term travel, accident-only, limited or 2 30 specified disease, or individual or group conversion 2 31 policies, or policies under Title XVIII of the Social 2 32 Security Act, or any other similar coverage under a 2 33 state or federal government plan. 2 34 7. A provision shall be made available to 2 35 policyholders, under group policies covering hospital, 2 36 medical, or surgical expenses, for payment of covered 2 37 services determined to be medically necessary provided 2 38 by registered nurses certified by a national 2 39 certifying organization, which organization shall be 2 40 identified by the Iowa board of nursing pursuant to 2 41 rules adopted by the board, if the services are within 2 42 the practice of the profession of a registered nurse 2 43 as that practice is defined in section 152.1, under 2 44 terms and conditions agreed upon between the insurer 2 45 and the policyholder, subject to utilization controls. 2 46 The provision shall also guarantee that any care or 2 47 treatment provided by registered nurses shall be 2 48 compensated at the same level as equivalent services 2 49 provided by a person licensed in the practice of 2 50 medicine and surgery under chapter 148 or 150A. This 3 1 subsection shall not require payment for nursing 3 2 services provided by a certified nurse practicing in a 3 3 hospital, nursing facility, health care institution, 3 4 physician's office, or other noninstitutional setting 3 5 if the certified nurse is an employee of the hospital, 3 6 nursing facility, health care institution, physician, 3 7 or other health care facility or health care provider. 3 8 This subsection applies to group policies delivered or 3 9 issued for delivery in this state on or after July 1, 3 10 1989, and to existing group policies on their next 3 11 anniversary or renewal dates, or upon expiration of 3 12 the applicable collective bargaining contract, if any, 3 13 whichever is later. This subsection does not apply to 3 14 blanket, short-term travel, accident only, limited or 3 15 specified disease, or individual or group conversion 3 16 policies, policies rated on a community basis, or 3 17 policies designed only for issuance to persons for 3 18 eligible coverage under Title XVIII of the federal 3 19 Social Security Act, or any other similar coverage 3 20 under a state or federal government plan. 3 21 Sec. . Section 509.3, Code 2003, is amended by 3 22 adding the following new subsection: 3 23 NEW SUBSECTION. 8. A provision shall be made 3 24 available to policyholders, under group policies 3 25 covering hospital, medical, or surgical expenses for 3 26 payment of necessary medical or surgical care and 3 27 treatment, as well as drug prescriptions, provided by 3 28 a person licensed to practice podiatry under chapter 3 29 149, if the care and treatment are provided within the 3 30 scope of the person's license and if the policy would 3 31 pay for the care and treatment if the care and 3 32 treatment were provided by a person engaged in the 3 33 practice of medicine and surgery as licensed under 3 34 chapter 148 or 150A. The provision shall also 3 35 guarantee that any medical or surgical services 3 36 provided by a podiatrist shall be compensated at the 3 37 same level as equivalent services provided by a person 3 38 licensed in the practice of medicine or surgery under 3 39 chapter 148 or 150A. The policy shall provide that 3 40 the policyholder may reject the coverage or provision 3 41 if the coverage or provision for similar services 3 42 which may be provided by a podiatric physician is 3 43 rejected for all providers of services as licensed 3 44 under chapter 148, 149, or 150A. This subsection 3 45 applies to group policies delivered or issued for 3 46 delivery on or after July 1, 2003, and to existing 3 47 group policies on their next anniversary or renewal 3 48 date, or upon expiration of the applicable collective 3 49 bargaining contract, if any, whichever is later. This 3 50 subsection does not apply to blanket, short-term 4 1 travel, accident only, limited or specified disease, 4 2 or individual or group conversion policies, or 4 3 policies designed only for issuance to persons for 4 4 coverage under Title XVIII of the federal Social 4 5 Security Act, or any other similar coverage under a 4 6 state or federal government plan. 4 7 Sec. . Section 509.3, unnumbered paragraph 2, 4 8 Code 2003, is amended to read as follows: 4 9 In addition to the provisions required in 4 10 subsections 1 through78, the commissioner shall 4 11 require provisions through the adoption of rules 4 12 implementing the federal Health Insurance Portability 4 13 and Accountability Act, Pub. L. No. 104-191. 4 14 Sec. . Section 514B.1, subsection 5, paragraphs 4 15 b, c, and d, Code 2003, are amended to read as 4 16 follows: 4 17 b. The health care services available to enrollees 4 18 under prepaid group plans covering vision care 4 19 services or procedures, shall include a provision for 4 20 payment of necessary medical or surgical care and 4 21 treatment provided by an optometrist licensed under 4 22 chapter 154, if performed within the scope of the 4 23 optometrist's license, and the plan would pay for the 4 24 care and treatment when the care and treatment were 4 25 provided by a person engaged in the practice of 4 26 medicine or surgery as licensed under chapter 148 or 4 27 150A. Additionally, any optometric medical or 4 28 surgical care and treatment provided shall be 4 29 compensated at the same level as equivalent services 4 30 provided by a person licensed in the practice of 4 31 medicine or surgery under chapter 148 or 150A. The 4 32 plan shall provide that the plan enrollees may reject 4 33 the coverage for services which may be provided by an 4 34 optometrist if the coverage is rejected for all 4 35 providers of similar vision care services as licensed 4 36 under chapter 148, 150A, or 154. This paragraph 4 37 applies to services provided under plans made after 4 38 July 1, 1983, and to existing group plans on their 4 39 next anniversary or renewal date, or upon the 4 40 expiration of the applicable collective bargaining 4 41 contract, if any, whichever is the later. This 4 42 paragraph does not apply to enrollees eligible for 4 43 coverage under Title XVIII of the Social Security Act 4 44 or any other similar coverage under a state or federal 4 45 government plan. 4 46 c. The health care services available to enrollees 4 47 under prepaid group plans covering diagnosis and 4 48 treatment of human ailments, shall include a provision 4 49 for payment of necessary diagnosis or treatment 4 50 provided by a chiropractor licensed under chapter 151 5 1 if the diagnosis or treatment is provided within the 5 2 scope of the chiropractor's license and if the plan 5 3 would pay or reimburse for the diagnosis or treatment 5 4 of human ailment, irrespective of and disregarding 5 5 variances in terminology employed by the various 5 6 licensed professions in describing the human ailment 5 7 or its diagnosis or its treatment, if it were provided 5 8 by a person licensed under chapter 148, 150, or 150A. 5 9 Additionally, any diagnosis and treatment provided by 5 10 a chiropractor shall be compensated at the same level 5 11 as equivalent services provided by a person licensed 5 12 in the practice of medicine or surgery under chapter 5 13 148 or 150A. The plan shall also provide that the 5 14 plan enrollees may reject the coverage for diagnosis 5 15 or treatment of a human ailment by a chiropractor if 5 16 the coverage is rejected for all providers of 5 17 diagnosis or treatment for similar human ailments 5 18 licensed under chapter 148, 150, 150A, or 151. A 5 19 prepaid group plan of health care services may limit 5 20 or make optional the payment or reimbursement for 5 21 lawful diagnostic or treatment service by all 5 22 licensees under chapters 148, 150, 150A, and 151 on 5 23 any rational basis which is not solely related to the 5 24 license under or the practices authorized by chapter 5 25 151 or is not dependent upon a method of 5 26 classification, categorization, or description based 5 27 upon differences in terminology used by different 5 28 licensees in describing human ailments or their 5 29 diagnosis or treatment. This paragraph applies to 5 30 services provided under plans made after July 1, 1986, 5 31 and to existing group plans on their next anniversary 5 32 or renewal date, or upon the expiration of the 5 33 applicable collective bargaining contract, if any, 5 34 whichever is the later. This paragraph does not apply 5 35 to enrollees eligible for coverage under Title XVIII 5 36 of the Social Security Act, or any other similar 5 37 coverage under a state or federal government plan. 5 38 d. The health care services available to enrollees 5 39 under prepaid group plans covering hospital, medical, 5 40 or surgical expenses, may include, at the option of 5 41 the employer purchaser, a provision for payment of 5 42 covered services determined to be medically necessary 5 43 provided by a certified registered nurse certified by 5 44 a national certifying organization, which organization 5 45 shall be identified by the Iowa board of nursing 5 46 pursuant to rules adopted by the board, if the 5 47 services are within the practice of the profession of 5 48 a registered nurse as that practice is defined in 5 49 section 152.1, under terms and conditions agreed upon 5 50 between the employer purchaser and the health 6 1 maintenance organization, subject to utilization 6 2 controls. Additionally, any covered services provided 6 3 by a registered nurse shall be compensated at the same 6 4 level as equivalent services provided by a person 6 5 licensed in the practice of medicine or surgery under 6 6 chapter 148 or 150A. This paragraph shall not require 6 7 payment for nursing services provided by a certified 6 8 registered nurse practicing in a hospital, nursing 6 9 facility, health care institution, a physician's 6 10 office, or other noninstitutional setting if the 6 11 certified registered nurse is an employee of the 6 12 hospital, nursing facility, health care institution, 6 13 physician, or other health care facility or health 6 14 care provider. This paragraph applies to services 6 15 provided under plans within this state made on or 6 16 after July 1, 1989, and to existing group plans on 6 17 their next anniversary or renewal date, or upon the 6 18 expiration of the applicable collective bargaining 6 19 contract, if any, whichever is later. This paragraph 6 20 does not apply to enrollees eligible for coverage 6 21 under an individual contract or coverage designed only 6 22 for issuance to enrollees eligible for coverage under 6 23 Title XVIII of the federal Social Security Act, or 6 24 under coverage which is rated on a community basis, or 6 25 any other similar coverage under a state or federal 6 26 government plan. 6 27 Sec. . Section 514B.1, subsection 5, Code 2003, 6 28 is amended by adding the following new paragraph: 6 29 NEW PARAGRAPH. e. The health care services 6 30 available to enrollees under prepaid group plans 6 31 covering hospital, medical, or surgical expenses shall 6 32 include a provision for payment of necessary medical 6 33 or surgical care and treatment as well as drug 6 34 prescriptions provided by a podiatric physician 6 35 licensed under chapter 149, if performed within the 6 36 scope of the podiatrist's license and the plan would 6 37 pay for the care and treatment when the care and 6 38 treatment were provided by a person engaged in the 6 39 practice of medicine or surgery as licensed under 6 40 chapter 148 or 150A. Additionally, any medical or 6 41 surgical service provided by a podiatrist shall be 6 42 compensated at the same level as equivalent services 6 43 provided by a person licensed in the practice of 6 44 medicine or surgery under chapter 148, 149, or 150A. 6 45 The plan shall provide that the plan enrollees may 6 46 reject the coverage for services which may be provided 6 47 by a podiatric physician if the coverage is rejected 6 48 for all providers of similar services as licensed 6 49 under chapter 148, 149, or 150A. This paragraph 6 50 applies to services provided under plans made on or 7 1 after July 1, 2003, and to existing group plans on 7 2 their next anniversary or renewal date, or upon the 7 3 expiration of the applicable collective bargaining 7 4 contract, if any, whichever is the later. This 7 5 paragraph does not apply to enrollees eligible for 7 6 coverage under Title XVIII of the federal Social 7 7 Security Act or any other similar coverage under a 7 8 state or federal government plan." 7 9 #2. By renumbering as necessary. 7 10 7 11 7 12 7 13 JOHN PUTNEY 7 14 7 15 7 16 7 17 MICHAEL E. GRONSTAL 7 18 7 19 7 20 7 21 MARY A. LUNDBY 7 22 JOHN P. KIBBIE 7 23 HF 667.510 80 7 24 pf/pj
Text: S03275 Text: S03277 Text: S03200 - S03299 Text: S Index Bills and Amendments: General Index Bill History: General Index
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