Text: SF02206 Text: SF02208 Text: SF02200 - SF02299 Text: SF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. Section 509.3, Code 2003, is amended by adding 1 2 the following new subsections: 1 3 NEW SUBSECTION. 8. a. A provision that any services 1 4 provided by a participating health care provider licensed 1 5 pursuant to chapter 149, 151, or 154, which services are 1 6 provided within the scope of practice of the health care 1 7 provider as that scope of practice is defined pursuant to 1 8 chapter 149, 151, or 154, shall be compensated at the same 1 9 level as equivalent services provided by a participating 1 10 provider licensed in the practice of medicine and surgery 1 11 pursuant to chapter 148 or 150A. 1 12 b. Services shall be deemed equivalent if the services are 1 13 described using the same current procedural terminology codes 1 14 as published by the American medical association, or any 1 15 successor coding system. 1 16 c. For the purposes of the current procedural terminology 1 17 code, or any successor code, which is restricted to use only 1 18 by specific health care providers with the exception of 1 19 providers licensed under chapter 148 or 150A, the same level 1 20 of compensation means the compensation level that has the same 1 21 ratio to the then-current payment levels in the federal 1 22 Medicare resource-based relative value system for those 1 23 restrictive codes as the compensation level for evaluation and 1 24 management services codes, any equivalent code utilitized 1 25 under the Medicare resource-based relative value system, or 1 26 any successor coding system has to the current payment levels 1 27 in the federal Medicare resource-based relative value system 1 28 for evaluation and management services codes. 1 29 d. This subsection shall not be interpreted to prohibit a 1 30 policy from reimbursing health care providers licensed 1 31 pursuant to chapter 149, 151, or 154, using a flat fee per 1 32 visit or per case if the fee bears a reasonable relationship 1 33 to the number and types of services provided and if the per 1 34 visit or per case fees are determined in a manner that is 1 35 consistent with the compensation parameters established in 2 1 paragraph "c". 2 2 NEW SUBSECTION. 9. A provision that a covered person 2 3 shall have direct access to any participating provider 2 4 licensed pursuant to section 149, 151, or 154, selected by the 2 5 covered person, without prior referral. 2 6 NEW SUBSECTION. 10. A provision that the person issuing 2 7 the policy shall ensure an adequate number of participating 2 8 providers to provide reasonable accessibility, timeliness of 2 9 care, convenience, and continuity of care to the covered 2 10 person. 2 11 Sec. 2. Section 509.3, unnumbered paragraph 2, Code 2003, 2 12 is amended to read as follows: 2 13 In addition to the provisions required in subsections 1 2 14 through710, the commissioner shall require provisions 2 15 through the adoption of rules implementing the federal Health 2 16 Insurance Portability and Accountability Act, Pub. L. No. 104- 2 17 191. 2 18 EXPLANATION 2 19 This bill provides that a policy of group accident or 2 20 health insurance or a combination of these that covers such 2 21 services is to include a provision that if the services are 2 22 provided by a health care provider licensed to be engaged in 2 23 the practice of podiatry, chiropractic, or optometry, and the 2 24 services provided are within the scope of practice of the 2 25 health care provider, the services are to be compensated at 2 26 the same level as equivalent services provided by a provider 2 27 licensed to practice medicine and surgery or osteopathic 2 28 medicine and surgery. The bill provides for deeming of 2 29 services as equivalent based on codes published by the 2 30 American medical association, and for determination of the 2 31 same level of compensation based on the federal Medicare 2 32 resource-based relative value system or an equivalent 2 33 successor coding system. The bill does not prohibit the use 2 34 of a flat fee reimbursement system if the compensation is 2 35 consistent with the compensation parameters established in the 3 1 bill. 3 2 Under the bill, a covered person is to have direct access 3 3 to a participating provider licensed to be engaged in the 3 4 practice of podiatry, chiropractic, or optometry rather than 3 5 being subject to prior referral. Additionally, the person 3 6 issuing the policy is to ensure adequate accessibility to 3 7 participating providers. 3 8 LSB 5932SV 80 3 9 pf/sh/8
Text: SF02206 Text: SF02208 Text: SF02200 - SF02299 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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