House
File
393
-
Enrolled
House
File
393
AN
ACT
RELATING
TO
PROGRAMS
AND
ACTIVITIES
UNDER
THE
PURVIEW
OF
THE
DEPARTMENT
OF
PUBLIC
HEALTH,
INCLUDING
EFFECTIVE
DATE
PROVISIONS
AND
PROVIDING
FOR
A
REPEAL.
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
DIVISION
I
PROGRAM
FLEXIBILITY
AND
EFFICIENCIES
Section
1.
Section
125.59,
subsection
1,
paragraph
b,
Code
2017,
is
amended
to
read
as
follows:
b.
If
the
transferred
amount
for
this
subsection
exceeds
grant
requests
funded
to
the
ten
thousand
dollar
maximum,
the
Iowa
department
of
public
health
may
use
the
remainder
for
activities
and
public
information
resources
that
align
with
best
practices
for
substance-related
disorder
prevention
or
to
increase
grants
pursuant
to
subsection
2
.
Sec.
2.
Section
135.11,
subsection
31,
Code
2017,
is
amended
by
striking
the
subsection.
Sec.
3.
Section
135.150,
subsection
2,
Code
2017,
is
amended
to
read
as
follows:
2.
The
department
shall
report
semiannually
annually
to
the
general
assembly’s
standing
committees
on
government
oversight
regarding
the
operation
of
the
gambling
treatment
program.
The
report
shall
include
but
is
not
limited
to
information
on
the
moneys
expended
and
grants
awarded
for
operation
of
the
gambling
treatment
program.
House
File
393,
p.
2
DIVISION
II
MEDICAL
HOME
AND
PATIENT-CENTERED
HEALTH
ADVISORY
COUNCIL
Sec.
4.
Section
135.15,
Code
2017,
is
amended
by
adding
the
following
new
subsection:
NEW
SUBSECTION
.
6.
For
the
purposes
of
this
section,
“dental
home”
means
a
network
of
individualized
care
based
on
risk
assessment,
which
includes
oral
health
education,
dental
screenings,
preventive
services,
diagnostic
services,
treatment
services,
and
emergency
services.
Sec.
5.
Section
135.159,
Code
2017,
is
amended
by
striking
the
section
and
inserting
in
lieu
thereof
the
following:
135.159
Patient-centered
health
advisory
council.
1.
The
department
shall
establish
a
patient-centered
health
advisory
council
which
shall
include
but
is
not
limited
to
all
of
the
following
members,
selected
by
their
respective
organizations,
and
any
other
members
the
department
determines
necessary:
a.
The
director
of
human
services,
or
the
director’s
designee.
b.
The
commissioner
of
insurance,
or
the
commissioner’s
designee.
c.
A
representative
of
the
federation
of
Iowa
insurers.
d.
A
representative
of
the
Iowa
dental
association.
e.
A
representative
of
the
Iowa
nurses
association.
f.
A
physician
and
an
osteopathic
physician
licensed
pursuant
to
chapter
148
who
are
family
physicians
and
members
of
the
Iowa
academy
of
family
physicians.
g.
A
health
care
consumer.
h.
A
representative
of
the
Iowa
collaborative
safety
net
provider
network
established
pursuant
to
section
135.153.
i.
A
representative
of
the
Iowa
developmental
disabilities
council.
j.
A
representative
of
the
Iowa
chapter
of
the
American
academy
of
pediatrics.
k.
A
representative
of
the
child
and
family
policy
center.
l.
A
representative
of
the
Iowa
pharmacy
association.
m.
A
representative
of
the
Iowa
chiropractic
society.
n.
A
representative
of
the
university
of
Iowa
college
of
public
health.
House
File
393,
p.
3
o.
A
certified
palliative
care
physician.
2.
The
patient-centered
health
advisory
council
may
utilize
the
assistance
of
other
relevant
public
health
and
health
care
expertise
when
necessary
to
carry
out
the
council’s
purposes
and
responsibilities.
3.
A
public
member
of
the
patient-centered
health
advisory
council
shall
receive
reimbursement
for
actual
expenses
incurred
while
serving
in
the
member’s
official
capacity
only
if
the
member
is
not
eligible
for
reimbursement
by
the
organization
the
member
represents.
4.
The
purposes
of
the
patient-centered
health
advisory
council
shall
include
all
of
the
following:
a.
To
serve
as
a
resource
on
emerging
health
care
transformation
initiatives
in
Iowa.
b.
To
convene
stakeholders
in
Iowa
to
streamline
efforts
that
support
state-level
and
community-level
integration
and
focus
on
reducing
fragmentation
of
the
health
care
system.
c.
To
encourage
partnerships
and
synergy
between
community
health
care
partners
in
the
state
who
are
working
on
new
system-level
models
to
provide
better
health
care
at
lower
costs
by
focusing
on
shifting
from
volume-based
to
value-based
health
care.
d.
To
lead
discussions
on
the
transformation
of
the
health
care
system
to
a
patient-centered
infrastructure
that
integrates
and
coordinates
services
and
supports
to
address
social
determinants
of
health
and
to
meet
population
health
goals.
e.
To
provide
a
venue
for
education
and
information
gathering
for
stakeholders
and
interested
parties
to
learn
about
emerging
health
care
initiatives
across
the
state.
f.
To
develop
recommendations
for
submission
to
the
department
related
to
health
care
transformation
issues.
Sec.
6.
Section
249N.2,
subsections
15
and
19,
Code
2017,
are
amended
to
read
as
follows:
15.
“Medical
home”
means
medical
home
as
defined
in
section
135.157
.
a
team
approach
to
providing
health
care
that
originates
in
a
primary
care
setting;
fosters
a
partnership
among
the
patient,
the
personal
provider,
and
other
health
care
professionals,
and
where
appropriate,
the
patient’s
family;
House
File
393,
p.
4
utilizes
the
partnership
to
access
and
integrate
all
medical
and
nonmedical
health-related
services
across
all
elements
of
the
health
care
system
and
the
patient’s
community
as
needed
by
the
patient
and
the
patient’s
family
to
achieve
maximum
health
potential;
maintains
a
centralized,
comprehensive
record
of
all
health-related
services
to
promote
continuity
of
care;
and
has
all
of
the
following
characteristics:
a.
A
personal
provider.
b.
A
provider-directed
team-based
medical
practice.
c.
Whole
person
orientation.
d.
Coordination
and
integration
of
care.
e.
Quality
and
safety.
f.
Enhanced
access
to
health
care.
g.
A
payment
system
that
appropriately
recognizes
the
added
value
provided
to
patients
who
have
a
patient-centered
medical
home.
19.
“Primary
medical
provider”
means
the
personal
provider
as
defined
in
section
135.157
trained
to
provide
first
contact
and
continuous
and
comprehensive
care
to
a
member,
chosen
by
a
member
or
to
whom
a
member
is
assigned
under
the
Iowa
health
and
wellness
plan.
Sec.
7.
Section
249N.2,
Code
2017,
is
amended
by
adding
the
following
new
subsections:
NEW
SUBSECTION
.
17A.
“Personal
provider”
means
the
patient’s
first
point
of
contact
in
the
health
care
system
with
a
primary
care
provider
who
identifies
the
patient’s
health-related
needs
and,
working
with
a
team
of
health
care
professionals
and
providers
of
medical
and
nonmedical
health-related
services,
provides
for
and
coordinates
appropriate
care
to
address
the
health-related
needs
identified.
NEW
SUBSECTION
.
18A.
“Primary
care
provider”
includes
but
is
not
limited
to
any
of
the
following
licensed
or
certified
health
care
professionals
who
provide
primary
care:
a.
A
physician
who
is
a
family
or
general
practitioner,
a
pediatrician,
an
internist,
an
obstetrician,
or
a
gynecologist.
b.
An
advanced
registered
nurse
practitioner.
c.
A
physician
assistant.
d.
A
chiropractor.
House
File
393,
p.
5
Sec.
8.
Section
249N.6,
subsection
2,
paragraph
c,
Code
2017,
is
amended
to
read
as
follows:
c.
The
department
shall
develop
a
mechanism
for
primary
medical
providers,
medical
homes,
and
participating
accountable
care
organizations
to
jointly
facilitate
member
care
coordination.
The
Iowa
health
and
wellness
plan
shall
provide
for
reimbursement
of
care
coordination
services
provided
under
the
plan
consistent
with
the
reimbursement
methodology
developed
pursuant
to
section
135.159
.
Sec.
9.
Section
249N.6,
subsection
3,
paragraph
a,
Code
2017,
is
amended
to
read
as
follows:
a.
The
department
shall
provide
procedures
for
accountable
care
organizations
that
emerge
through
local
markets
to
participate
in
the
Iowa
health
and
wellness
plan
provider
network.
Such
accountable
care
organizations
shall
incorporate
the
medical
home
as
defined
and
specified
in
chapter
135,
division
XXII
,
as
a
foundation
and
shall
emphasize
whole-person
orientation
and
coordination
and
integration
of
both
clinical
services
and
nonclinical
community
and
social
supports
that
address
social
determinants
of
health.
A
participating
accountable
care
organization
shall
enter
into
a
contract
with
the
department
to
ensure
the
coordination
and
management
of
the
health
of
attributed
members,
to
produce
quality
health
care
outcomes,
and
to
control
overall
cost.
Sec.
10.
PALLIATIVE
CARE
REVIEW
——
PATIENT-CENTERED
HEALTH
ADVISORY
COUNCIL.
The
patient-centered
health
advisory
council
shall
review
the
current
level
of
public
awareness
regarding
and
the
availability
of
palliative
care
services
in
the
state
and
shall
submit
a
report
to
the
governor
and
the
general
assembly
by
December
31,
2017,
including
the
council’s
findings
and
providing
recommendations
to
increase
public
awareness
and
reduce
barriers
to
access
to
palliative
care
services
throughout
the
state.
Sec.
11.
REPEAL.
Sections
135.157
and
135.158,
Code
2017,
are
repealed.
DIVISION
III
WORKFORCE
PROGRAMMING
Sec.
12.
Section
84A.11,
subsection
4,
Code
2017,
is
amended
to
read
as
follows:
House
File
393,
p.
6
4.
The
nursing
workforce
data
clearinghouse
shall
be
established
and
maintained
in
a
manner
consistent
with
the
health
care
delivery
infrastructure
and
health
care
workforce
resources
strategic
plan
developed
pursuant
to
section
135.164
135.163
.
Sec.
13.
Section
135.107,
subsection
3,
Code
2017,
is
amended
to
read
as
follows:
3.
The
center
for
rural
health
and
primary
care
shall
establish
a
primary
care
provider
recruitment
and
retention
endeavor,
to
be
known
as
PRIMECARRE.
The
endeavor
shall
include
a
health
care
workforce
and
community
support
grant
program
,
and
a
primary
care
provider
loan
repayment
program
,
and
a
primary
care
provider
community
scholarship
program
.
The
endeavor
shall
be
developed
and
implemented
in
a
manner
to
promote
and
accommodate
local
creativity
in
efforts
to
recruit
and
retain
health
care
professionals
to
provide
services
in
the
locality.
The
focus
of
the
endeavor
shall
be
to
promote
and
assist
local
efforts
in
developing
health
care
provider
recruitment
and
retention
programs.
The
center
for
rural
health
and
primary
care
may
enter
into
an
agreement
with
the
college
student
aid
commission
for
the
administration
of
the
center’s
grant
and
loan
repayment
programs.
a.
Community
Health
care
workforce
and
community
support
grant
program.
(1)
The
center
for
rural
health
and
primary
care
shall
adopt
rules
establishing
an
flexible
application
process
processes
based
upon
the
department’s
strategic
plan
to
be
used
by
the
center
to
establish
a
grant
assistance
program
as
provided
in
this
paragraph
“a”
,
and
establishing
the
criteria
to
be
used
in
evaluating
the
applications.
Selection
criteria
shall
include
a
method
for
prioritizing
grant
applications
based
on
illustrated
efforts
to
meet
the
health
care
provider
needs
of
the
locality
and
surrounding
area.
Such
assistance
may
be
in
the
form
of
a
forgivable
loan,
grant,
or
other
nonfinancial
assistance
as
deemed
appropriate
by
the
center.
An
application
submitted
shall
may
contain
a
commitment
of
at
least
a
dollar-for-dollar
match
of
matching
funds
for
the
grant
assistance.
Application
may
be
made
for
assistance
by
a
single
community
or
group
of
communities
or
in
response
to
programs
House
File
393,
p.
7
recommended
in
the
strategic
plan
to
address
health
workforce
shortages
.
(2)
Grants
awarded
under
the
program
shall
be
subject
to
the
following
limitations:
(a)
Ten
thousand
dollars
for
a
single
community
or
region
with
a
population
of
ten
thousand
or
less.
An
award
shall
not
be
made
under
this
program
to
a
community
with
a
population
of
more
than
ten
thousand.
(b)
An
amount
not
to
exceed
one
dollar
per
capita
for
a
region
in
which
the
population
exceeds
ten
thousand.
For
purposes
of
determining
the
amount
of
a
grant
for
a
region,
the
population
of
the
region
shall
not
include
the
population
of
any
community
with
a
population
of
more
than
ten
thousand
located
in
the
region
awarded
to
rural,
underserved
areas
or
special
populations
as
identified
by
the
department’s
strategic
plan
or
evidence-based
documentation
.
b.
Primary
care
provider
loan
repayment
program.
(1)
A
primary
care
provider
loan
repayment
program
is
established
to
increase
the
number
of
health
professionals
practicing
primary
care
in
federally
designated
health
professional
shortage
areas
of
the
state.
Under
the
program,
loan
repayment
may
be
made
to
a
recipient
for
educational
expenses
incurred
while
completing
an
accredited
health
education
program
directly
related
to
obtaining
credentials
necessary
to
practice
the
recipient’s
health
profession.
(2)
The
center
for
rural
health
and
primary
care
shall
adopt
rules
relating
to
the
establishment
and
administration
of
the
primary
care
provider
loan
repayment
program.
Rules
adopted
pursuant
to
this
paragraph
shall
provide,
at
a
minimum,
for
all
of
the
following:
(a)
Determination
of
eligibility
requirements
and
qualifications
of
an
applicant
to
receive
loan
repayment
under
the
program,
including
but
not
limited
to
years
of
obligated
service,
clinical
practice
requirements,
and
residency
requirements.
One
year
of
obligated
service
shall
be
provided
by
the
applicant
in
exchange
for
each
year
of
loan
repayment,
unless
federal
requirements
otherwise
require.
Loan
repayment
under
the
program
shall
not
be
approved
for
a
health
provider
whose
license
or
certification
is
restricted
by
a
medical
House
File
393,
p.
8
regulatory
authority
of
any
jurisdiction
of
the
United
States,
other
nations,
or
territories.
(b)
Identification
of
federally
designated
health
professional
shortage
areas
of
the
state
and
prioritization
of
such
areas
according
to
need.
(c)
Determination
of
the
amount
and
duration
of
the
loan
repayment
an
applicant
may
receive,
giving
consideration
to
the
availability
of
funds
under
the
program,
and
the
applicant’s
outstanding
educational
loans
and
professional
credentials.
(d)
Determination
of
the
conditions
of
loan
repayment
applicable
to
an
applicant.
(e)
Enforcement
of
the
state’s
rights
under
a
loan
repayment
program
contract,
including
the
commencement
of
any
court
action.
(f)
Cancellation
of
a
loan
repayment
program
contract
for
reasonable
cause
unless
federal
requirements
otherwise
require
.
(g)
Participation
in
federal
programs
supporting
repayment
of
loans
of
health
care
providers
and
acceptance
of
gifts,
grants,
and
other
aid
or
amounts
from
any
person,
association,
foundation,
trust,
corporation,
governmental
agency,
or
other
entity
for
the
purposes
of
the
program.
(h)
Upon
availability
of
state
funds,
determination
of
eligibility
criteria
and
qualifications
for
participating
communities
and
applicants
not
located
in
federally
designated
shortage
areas.
(i)
Other
rules
as
necessary.
(3)
The
center
for
rural
health
and
primary
care
may
enter
into
an
agreement
under
chapter
28E
with
the
college
student
aid
commission
for
the
administration
of
this
program.
c.
Primary
care
provider
community
scholarship
program.
(1)
A
primary
care
provider
community
scholarship
program
is
established
to
recruit
and
to
provide
scholarships
to
train
primary
health
care
practitioners
in
federally
designated
health
professional
shortage
areas
of
the
state.
Under
the
program,
scholarships
may
be
awarded
to
a
recipient
for
educational
expenses
incurred
while
completing
an
accredited
health
education
program
directly
related
to
obtaining
the
credentials
necessary
to
practice
the
recipient’s
health
profession.
House
File
393,
p.
9
(2)
The
department
shall
adopt
rules
relating
to
the
establishment
and
administration
of
the
primary
care
provider
community
scholarship
program.
Rules
adopted
pursuant
to
this
paragraph
shall
provide,
at
a
minimum,
for
all
of
the
following:
(a)
Determination
of
eligibility
requirements
and
qualifications
of
an
applicant
to
receive
scholarships
under
the
program,
including
but
not
limited
to
years
of
obligated
service,
clinical
practice
requirements,
and
residency
requirements.
One
year
of
obligated
service
shall
be
provided
by
the
applicant
in
exchange
for
each
year
of
scholarship
receipt,
unless
federal
requirements
otherwise
require.
(b)
Identification
of
federally
designated
health
professional
shortage
areas
of
the
state
and
prioritization
of
such
areas
according
to
need.
(c)
Determination
of
the
amount
of
the
scholarship
an
applicant
may
receive.
(d)
Determination
of
the
conditions
of
scholarship
to
be
awarded
to
an
applicant.
(e)
Enforcement
of
the
state’s
rights
under
a
scholarship
contract,
including
the
commencement
of
any
court
action.
(f)
Cancellation
of
a
scholarship
contract
for
reasonable
cause.
(g)
Participation
in
federal
programs
supporting
scholarships
for
health
care
providers
and
acceptance
of
gifts,
grants,
and
other
aid
or
amounts
from
any
person,
association,
foundation,
trust,
corporation,
governmental
agency,
or
other
entity
for
the
purposes
of
the
program.
(h)
Upon
availability
of
state
funds,
determination
of
eligibility
criteria
and
qualifications
for
participating
communities
and
applicants
not
located
in
federally
designated
shortage
areas.
(i)
Other
rules
as
necessary.
(3)
The
center
for
rural
health
and
primary
care
may
enter
into
an
agreement
under
chapter
28E
with
the
college
student
aid
commission
for
the
administration
of
this
program.
Sec.
14.
Section
135.107,
subsection
4,
paragraphs
a,
b,
and
c,
Code
2017,
are
amended
to
read
as
follows:
a.
Eligibility
under
any
of
the
programs
established
under
House
File
393,
p.
10
the
primary
care
provider
recruitment
and
retention
endeavor
shall
be
based
upon
a
community
health
services
assessment
completed
under
subsection
2
,
paragraph
“a”
.
A
community
or
region,
as
applicable,
shall
submit
a
letter
of
intent
to
conduct
a
community
health
services
assessment
and
to
apply
for
assistance
under
this
subsection
.
The
letter
shall
be
in
a
form
and
contain
information
as
determined
by
the
center.
A
letter
of
intent
shall
be
submitted
to
the
center
by
January
1
preceding
the
fiscal
year
for
which
an
application
for
assistance
is
to
be
made.
Participation
in
a
community
health
services
assessment
process
shall
be
documented
by
the
community
or
region.
b.
Assistance
under
this
subsection
shall
not
be
granted
until
such
time
as
the
community
or
region
making
application
has
completed
the
a
community
health
services
assessment
and
adopted
a
long-term
community
health
services
assessment
and
developmental
plan.
In
addition
to
any
other
requirements,
a
developmental
an
applicant’s
plan
shall
include
,
to
the
extent
possible,
a
clear
commitment
to
informing
high
school
students
of
the
health
care
opportunities
which
may
be
available
to
such
students.
c.
The
center
for
rural
health
and
primary
care
shall
seek
additional
assistance
and
resources
from
other
state
departments
and
agencies,
federal
agencies
and
grant
programs,
private
organizations,
and
any
other
person,
as
appropriate.
The
center
is
authorized
and
directed
to
accept
on
behalf
of
the
state
any
grant
or
contribution,
federal
or
otherwise,
made
to
assist
in
meeting
the
cost
of
carrying
out
the
purpose
of
this
subsection
.
All
federal
grants
to
and
the
federal
receipts
of
the
center
are
appropriated
for
the
purpose
set
forth
in
such
federal
grants
or
receipts.
Funds
appropriated
by
the
general
assembly
to
the
center
for
implementation
of
this
subsection
shall
first
be
used
for
securing
any
available
federal
funds
requiring
a
state
match,
with
remaining
funds
being
used
for
the
health
care
workforce
and
community
support
grant
program.
Sec.
15.
Section
135.107,
subsection
5,
paragraph
a,
Code
2017,
is
amended
to
read
as
follows:
a.
There
is
established
an
advisory
committee
to
the
House
File
393,
p.
11
center
for
rural
health
and
primary
care
consisting
of
one
representative,
approved
by
the
respective
agency,
of
each
of
the
following
agencies:
the
department
of
agriculture
and
land
stewardship,
the
Iowa
department
of
public
health,
the
department
of
inspections
and
appeals,
the
a
national
or
regional
institute
for
rural
health
policy,
the
rural
health
resource
center,
the
institute
of
agricultural
medicine
and
occupational
health,
and
the
Iowa
state
association
of
counties.
The
governor
shall
appoint
two
representatives
of
consumer
groups
active
in
rural
health
issues
and
a
representative
of
each
of
two
farm
organizations
active
within
the
state,
a
representative
of
an
agricultural
business
in
the
state,
a
representative
of
a
critical
needs
hospital,
a
practicing
rural
family
physician,
a
practicing
rural
physician
assistant,
a
practicing
rural
advanced
registered
nurse
practitioner,
and
a
rural
health
practitioner
who
is
not
a
physician,
physician
assistant,
or
advanced
registered
nurse
practitioner,
as
members
of
the
advisory
committee.
The
advisory
committee
shall
also
include
as
members
two
state
representatives,
one
appointed
by
the
speaker
of
the
house
of
representatives
and
one
by
the
minority
leader
of
the
house,
and
two
state
senators,
one
appointed
by
the
majority
leader
of
the
senate
and
one
by
the
minority
leader
of
the
senate.
Sec.
16.
Section
135.163,
Code
2017,
is
amended
to
read
as
follows:
135.163
Health
and
long-term
care
access.
The
department
shall
coordinate
public
and
private
efforts
to
develop
and
maintain
an
appropriate
health
care
delivery
infrastructure
and
a
stable,
well-qualified,
diverse,
and
sustainable
health
care
workforce
in
this
state.
The
health
care
delivery
infrastructure
and
the
health
care
workforce
shall
address
the
broad
spectrum
of
health
care
needs
of
Iowans
throughout
their
lifespan
including
long-term
care
needs
.
The
department
shall,
at
a
minimum,
do
all
of
the
following:
1.
Develop
a
strategic
plan
for
health
care
delivery
infrastructure
and
health
care
workforce
resources
in
this
state.
2.
Provide
for
the
continuous
collection
of
data
to
provide
a
basis
for
health
care
strategic
planning
and
health
care
House
File
393,
p.
12
policymaking.
3.
Make
recommendations
regarding
the
health
care
delivery
infrastructure
and
the
health
care
workforce
that
assist
in
monitoring
current
needs,
predicting
future
trends,
and
informing
policymaking.
Sec.
17.
Section
135.175,
subsection
1,
paragraph
b,
Code
2017,
is
amended
to
read
as
follows:
b.
A
health
care
workforce
shortage
fund
is
created
in
the
state
treasury
as
a
separate
fund
under
the
control
of
the
department,
in
cooperation
with
the
entities
identified
in
this
section
as
having
control
over
the
accounts
within
the
fund.
The
fund
and
the
accounts
within
the
fund
shall
be
controlled
and
managed
in
a
manner
consistent
with
the
principles
specified
and
the
strategic
plan
developed
pursuant
to
sections
section
135.163
and
135.164
.
Sec.
18.
Section
135.175,
subsections
6
and
7,
Code
2017,
are
amended
to
read
as
follows:
6.
a.
Moneys
in
the
fund
and
the
accounts
in
the
fund
shall
only
be
appropriated
in
a
manner
consistent
with
the
principles
specified
and
the
strategic
plan
developed
pursuant
to
sections
section
135.163
and
135.164
to
support
the
medical
residency
training
state
matching
grants
program,
the
fulfilling
Iowa’s
need
for
dentists
matching
grant
program,
and
to
provide
funding
for
state
health
care
workforce
shortage
programs
as
provided
in
this
section
.
b.
State
programs
that
may
receive
funding
from
the
fund
and
the
accounts
in
the
fund,
if
specifically
designated
for
the
purpose
of
drawing
down
federal
funding,
are
the
primary
care
recruitment
and
retention
endeavor
(PRIMECARRE),
the
Iowa
affiliate
of
the
national
rural
recruitment
and
retention
network,
the
oral
and
health
delivery
systems
bureau
of
the
department,
the
primary
care
office
and
shortage
designation
program,
and
the
state
office
of
rural
health,
and
the
Iowa
health
workforce
center,
administered
through
the
oral
and
health
delivery
systems
bureau
of
health
care
access
of
the
department
of
public
health;
the
area
health
education
centers
programs
at
Des
Moines
university
——
osteopathic
medical
center
and
the
university
of
Iowa;
the
Iowa
collaborative
safety
net
provider
network
established
pursuant
to
section
135.153
;
any
House
File
393,
p.
13
entity
identified
by
the
federal
government
entity
through
which
federal
funding
for
a
specified
health
care
workforce
shortage
initiative
is
received;
and
a
program
developed
in
accordance
with
the
strategic
plan
developed
by
the
department
of
public
health
in
accordance
with
sections
section
135.163
and
135.164
.
c.
State
appropriations
to
the
fund
shall
be
allocated
in
equal
amounts
to
each
of
the
accounts
within
the
fund,
unless
otherwise
specified
in
the
appropriation
or
allocation.
Any
federal
funding
received
for
the
purposes
of
addressing
state
health
care
workforce
shortages
shall
be
deposited
in
the
health
care
workforce
shortage
national
initiatives
account,
unless
otherwise
specified
by
the
source
of
the
funds,
and
shall
be
used
as
required
by
the
source
of
the
funds.
If
use
of
the
federal
funding
is
not
designated,
the
funds
shall
be
used
in
accordance
with
the
strategic
plan
developed
by
the
department
of
public
health
in
accordance
with
sections
section
135.163
and
135.164
,
or
to
address
workforce
shortages
as
otherwise
designated
by
the
department
of
public
health.
Other
sources
of
funding
shall
be
deposited
in
the
fund
or
account
and
used
as
specified
by
the
source
of
the
funding.
7.
No
more
than
five
percent
of
the
moneys
in
any
of
the
accounts
within
the
fund
,
not
to
exceed
one
hundred
thousand
dollars
in
each
account,
shall
be
used
for
administrative
purposes,
unless
otherwise
provided
by
the
appropriation,
allocation,
or
source
of
the
funds.
Sec.
19.
REPEAL.
Sections
135.164
and
135.180,
Code
2017,
are
repealed.
DIVISION
IV
UNFUNDED
OR
OUTDATED
PROGRAM
PROVISIONS
Sec.
20.
Section
135.11,
subsection
25,
Code
2017,
is
amended
by
striking
the
subsection.
Sec.
21.
Section
135.141,
subsection
2,
paragraph
c,
Code
2017,
is
amended
by
striking
the
paragraph.
Sec.
22.
Section
135.141,
subsection
2,
paragraph
e,
Code
2017,
is
amended
to
read
as
follows:
e.
For
the
purpose
of
paragraphs
“c”
and
paragraph
“d”
,
an
employee
or
agent
of
the
department
may
enter
into
and
examine
any
premises
containing
potentially
dangerous
agents
House
File
393,
p.
14
with
the
consent
of
the
owner
or
person
in
charge
of
the
premises
or,
if
the
owner
or
person
in
charge
of
the
premises
refuses
admittance,
with
an
administrative
search
warrant
obtained
under
section
808.14
.
Based
on
findings
of
the
risk
assessment
and
examination
of
the
premises,
the
director
may
order
reasonable
safeguards
or
take
any
other
action
reasonably
necessary
to
protect
the
public
health
pursuant
to
rules
adopted
to
administer
this
subsection
.
Sec.
23.
Section
901B.1,
subsection
4,
paragraph
a,
Code
2017,
is
amended
to
read
as
follows:
a.
The
district
department
of
correctional
services
shall
place
an
individual
committed
to
it
under
section
907.3
to
the
sanction
and
level
of
supervision
which
is
appropriate
to
the
individual
based
upon
a
current
risk
assessment
evaluation.
Placements
may
be
to
levels
two
and
three
of
the
corrections
continuum.
The
district
department
may,
with
the
approval
of
the
Iowa
department
of
public
health
and
the
department
of
corrections,
place
an
individual
in
a
level
three
substance
abuse
treatment
facility
established
pursuant
to
section
135.130
,
to
assist
the
individual
in
complying
with
a
condition
of
probation.
The
district
department
may,
with
the
approval
of
the
department
of
corrections,
place
an
individual
in
a
level
four
violator
facility
established
pursuant
to
section
904.207
only
as
a
penalty
for
a
violation
of
a
condition
imposed
under
this
section
.
Sec.
24.
REPEAL.
Sections
135.26,
135.29,
135.130,
and
135.152,
Code
2017,
are
repealed.
DIVISION
V
MISCELLANEOUS
PROVISIONS
Sec.
25.
Section
135A.2,
subsection
6,
Code
2017,
is
amended
to
read
as
follows:
6.
“Local
board
of
health”
means
a
county
or
district
board
of
health
the
same
as
defined
in
section
137.102
.
Sec.
26.
REPEAL.
Section
135.132,
Code
2017,
is
repealed.
DIVISION
VI
IOWA
HEALTH
INFORMATION
NETWORK
Sec.
27.
Section
136.3,
subsection
13,
Code
2017,
is
amended
by
striking
the
subsection.
Sec.
28.
EFFECTIVE
DATE.
This
division
of
this
Act
House
File
393,
p.
15
takes
effect
upon
the
assumption
of
the
administration
and
governance,
including
but
not
limited
to
the
assumption
of
the
assets
and
liabilities,
of
the
Iowa
health
information
network
by
the
designated
entity
as
defined
in
2015
Iowa
Acts,
ch.
73,
section
2.
The
department
of
public
health
shall
notify
the
Code
editor
of
the
date
of
such
assumption
by
the
designated
entity.
DIVISION
VII
ORGANIZED
DELIVERY
SYSTEMS
Sec.
29.
Section
135H.3,
subsection
2,
Code
2017,
is
amended
to
read
as
follows:
2.
If
a
child
is
diagnosed
with
a
biologically
based
mental
illness
as
defined
in
section
514C.22
and
meets
the
medical
assistance
program
criteria
for
admission
to
a
psychiatric
medical
institution
for
children,
the
child
shall
be
deemed
to
meet
the
acuity
criteria
for
medically
necessary
inpatient
benefits
under
a
group
policy,
contract,
or
plan
providing
for
third-party
payment
or
prepayment
of
health,
medical,
and
surgical
coverage
benefits
issued
by
a
carrier,
as
defined
in
section
513B.2
,
or
by
an
organized
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158,
that
is
subject
to
section
514C.22
.
Such
medically
necessary
benefits
shall
not
be
excluded
or
denied
as
care
that
is
substantially
custodial
in
nature
under
section
514C.22,
subsection
8
,
paragraph
“b”
.
Sec.
30.
Section
505.32,
subsection
2,
paragraph
h,
Code
2017,
is
amended
by
striking
the
paragraph.
Sec.
31.
Section
505.32,
subsection
4,
paragraph
b,
subparagraphs
(1)
and
(2),
Code
2017,
are
amended
to
read
as
follows:
(1)
The
commissioner
may
establish
methodologies
to
provide
uniform
and
consistent
side-by-side
comparisons
of
the
health
care
coverage
options
that
are
offered
by
carriers
,
organized
delivery
systems,
and
public
programs
in
this
state
including
but
not
limited
to
benefits
covered
and
not
covered,
the
amount
of
coverage
for
each
service,
including
copays
and
deductibles,
administrative
costs,
and
any
prior
authorization
requirements
for
coverage.
(2)
The
commissioner
may
require
each
carrier
,
organized
delivery
system,
and
public
program
in
this
state
to
describe
House
File
393,
p.
16
each
health
care
coverage
option
offered
by
that
carrier
,
organized
delivery
system,
or
public
program
in
a
manner
so
that
the
various
options
can
be
compared
as
provided
in
subparagraph
(1).
Sec.
32.
Section
507B.4,
subsection
1,
Code
2017,
is
amended
to
read
as
follows:
1.
For
purposes
of
subsection
3
,
paragraph
“p”
,
“insurer”
means
an
entity
providing
a
plan
of
health
insurance,
health
care
benefits,
or
health
care
services,
or
an
entity
subject
to
the
jurisdiction
of
the
commissioner
performing
utilization
review,
including
an
insurance
company
offering
sickness
and
accident
plans,
a
health
maintenance
organization,
an
organized
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158
,
and
licensed
by
the
department
of
public
health,
a
nonprofit
health
service
corporation,
a
plan
established
pursuant
to
chapter
509A
for
public
employees,
or
any
other
entity
providing
a
plan
of
health
insurance,
health
care
benefits,
or
health
care
services.
However,
“insurer”
does
not
include
an
entity
that
sells
disability
income
or
long-term
care
insurance.
Sec.
33.
Section
507B.4A,
subsection
2,
paragraph
a,
Code
2017,
is
amended
to
read
as
follows:
a.
An
insurer
providing
accident
and
sickness
insurance
under
chapter
509
,
514
,
or
514A
;
a
health
maintenance
organization;
an
organized
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158
,
and
licensed
by
the
department
of
public
health;
or
another
entity
providing
health
insurance
or
health
benefits
subject
to
state
insurance
regulation
shall
either
accept
and
pay
or
deny
a
clean
claim.
Sec.
34.
Section
509.3A,
subsection
11,
Code
2017,
is
amended
by
striking
the
subsection.
Sec.
35.
Section
509.19,
subsection
2,
paragraph
d,
Code
2017,
is
amended
by
striking
the
paragraph.
Sec.
36.
Section
509A.6,
Code
2017,
is
amended
to
read
as
follows:
509A.6
Contract
with
insurance
carrier
,
or
health
maintenance
organization
,
or
organized
delivery
system
.
The
governing
body
may
contract
with
a
nonprofit
corporation
operating
under
the
provisions
of
this
chapter
or
chapter
514
or
with
any
insurance
company
having
a
certificate
of
House
File
393,
p.
17
authority
to
transact
an
insurance
business
in
this
state
with
respect
of
a
group
insurance
plan,
which
may
include
life,
accident,
health,
hospitalization
and
disability
insurance
during
period
of
active
service
of
such
employees,
with
the
right
of
any
employee
to
continue
such
life
insurance
in
force
after
termination
of
active
service
at
such
employee’s
sole
expense;
may
contract
with
a
nonprofit
corporation
operating
under
and
governed
by
the
provisions
of
this
chapter
or
chapter
514
with
respect
of
any
hospital
or
medical
service
plan;
and
may
contract
with
a
health
maintenance
organization
or
an
organized
delivery
system
authorized
to
operate
in
this
state
with
respect
to
health
maintenance
organization
or
organized
delivery
system
activities.
Sec.
37.
Section
513B.2,
subsection
8,
paragraph
k,
Code
2017,
is
amended
by
striking
the
paragraph.
Sec.
38.
Section
513B.5,
Code
2017,
is
amended
to
read
as
follows:
513B.5
Provisions
on
renewability
of
coverage.
1.
Health
insurance
coverage
subject
to
this
chapter
is
renewable
with
respect
to
all
eligible
employees
or
their
dependents,
at
the
option
of
the
small
employer,
except
for
one
or
more
of
the
following
reasons:
a.
The
health
insurance
coverage
sponsor
fails
to
pay,
or
to
make
timely
payment
of,
premiums
or
contributions
pursuant
to
the
terms
of
the
health
insurance
coverage.
b.
The
health
insurance
coverage
sponsor
performs
an
act
or
practice
constituting
fraud
or
makes
an
intentional
misrepresentation
of
a
material
fact
under
the
terms
of
the
coverage.
c.
Noncompliance
with
the
carrier’s
or
organized
delivery
system’s
minimum
participation
requirements.
d.
Noncompliance
with
the
carrier’s
or
organized
delivery
system’s
employer
contribution
requirements.
e.
A
decision
by
the
carrier
or
organized
delivery
system
to
discontinue
offering
a
particular
type
of
health
insurance
coverage
in
the
state’s
small
employer
market.
Health
insurance
coverage
may
be
discontinued
by
the
carrier
or
organized
delivery
system
in
that
market
only
if
the
carrier
or
organized
delivery
system
does
all
of
the
following:
House
File
393,
p.
18
(1)
Provides
advance
notice
of
its
decision
to
discontinue
such
plan
to
the
commissioner
or
director
of
public
health
.
Notice
to
the
commissioner
or
director
,
at
a
minimum,
shall
be
no
less
than
three
days
prior
to
the
notice
provided
for
in
subparagraph
(2)
to
affected
small
employers,
participants,
and
beneficiaries.
(2)
Provides
notice
of
its
decision
not
to
renew
such
plan
to
all
affected
small
employers,
participants,
and
beneficiaries
no
less
than
ninety
days
prior
to
the
nonrenewal
of
the
plan.
(3)
Offers
to
each
plan
sponsor
of
the
discontinued
coverage,
the
option
to
purchase
any
other
coverage
currently
offered
by
the
carrier
or
organized
delivery
system
to
other
employers
in
this
state.
(4)
Acts
uniformly,
in
opting
to
discontinue
the
coverage
and
in
offering
the
option
under
subparagraph
(3),
without
regard
to
the
claims
experience
of
the
sponsors
under
the
discontinued
coverage
or
to
a
health
status-related
factor
relating
to
any
participants
or
beneficiaries
covered
or
new
participants
or
beneficiaries
who
may
become
eligible
for
the
coverage.
f.
A
decision
by
the
carrier
or
organized
delivery
system
to
discontinue
offering
and
to
cease
to
renew
all
of
its
health
insurance
coverage
delivered
or
issued
for
delivery
to
small
employers
in
this
state.
A
carrier
or
organized
delivery
system
making
such
decision
shall
do
all
of
the
following:
(1)
Provide
advance
notice
of
its
decision
to
discontinue
such
coverage
to
the
commissioner
or
director
of
public
health
.
Notice
to
the
commissioner
or
director
,
at
a
minimum,
shall
be
no
less
than
three
days
prior
to
the
notice
provided
for
in
subparagraph
(2)
to
affected
small
employers,
participants,
and
beneficiaries.
(2)
Provide
notice
of
its
decision
not
to
renew
such
coverage
to
all
affected
small
employers,
participants,
and
beneficiaries
no
less
than
one
hundred
eighty
days
prior
to
the
nonrenewal
of
the
coverage.
(3)
Discontinue
all
health
insurance
coverage
issued
or
delivered
for
issuance
to
small
employers
in
this
state
and
cease
renewal
of
such
coverage.
House
File
393,
p.
19
g.
The
membership
of
an
employer
in
an
association,
which
is
the
basis
for
the
coverage
which
is
provided
through
such
association,
ceases,
but
only
if
the
termination
of
coverage
under
this
paragraph
occurs
uniformly
without
regard
to
any
health
status-related
factor
relating
to
any
covered
individual.
h.
The
commissioner
or
director
of
public
health
finds
that
the
continuation
of
the
coverage
is
not
in
the
best
interests
of
the
policyholders
or
certificate
holders,
or
would
impair
the
carrier’s
or
organized
delivery
system’s
ability
to
meet
its
contractual
obligations.
i.
At
the
time
of
coverage
renewal,
a
carrier
or
organized
delivery
system
may
modify
the
health
insurance
coverage
for
a
product
offered
under
group
health
insurance
coverage
in
the
small
group
market,
for
coverage
that
is
available
in
such
market
other
than
only
through
one
or
more
bona
fide
associations,
if
such
modification
is
consistent
with
the
laws
of
this
state,
and
is
effective
on
a
uniform
basis
among
group
health
insurance
coverage
with
that
product.
2.
A
carrier
or
organized
delivery
system
that
elects
not
to
renew
health
insurance
coverage
under
subsection
1
,
paragraph
“f”
,
shall
not
write
any
new
business
in
the
small
employer
market
in
this
state
for
a
period
of
five
years
after
the
date
of
notice
to
the
commissioner
or
director
of
public
health
.
3.
This
section
,
with
respect
to
a
carrier
or
organized
delivery
system
doing
business
in
one
established
geographic
service
area
of
the
state,
applies
only
to
such
carrier’s
or
organized
delivery
system’s
operations
in
that
service
area.
Sec.
39.
Section
513B.6,
unnumbered
paragraph
1,
Code
2017,
is
amended
to
read
as
follows:
A
small
employer
carrier
or
organized
delivery
system
shall
make
reasonable
disclosure
in
solicitation
and
sales
materials
provided
to
small
employers
of
all
of
the
following:
Sec.
40.
Section
513B.6,
subsection
2,
Code
2017,
is
amended
to
read
as
follows:
2.
The
provisions
concerning
the
small
employer
carrier’s
or
organized
delivery
system’s
right
to
change
premium
rates
and
factors,
including
case
characteristics,
which
affect
changes
in
premium
rates.
House
File
393,
p.
20
Sec.
41.
Section
513B.7,
Code
2017,
is
amended
to
read
as
follows:
513B.7
Maintenance
of
records.
1.
A
small
employer
carrier
or
organized
delivery
system
shall
maintain
at
its
principal
place
of
business
a
complete
and
detailed
description
of
its
rating
practices
and
renewal
underwriting
practices,
including
information
and
documentation
which
demonstrate
that
its
rating
methods
and
practices
are
based
upon
commonly
accepted
actuarial
assumptions
and
are
in
accordance
with
sound
actuarial
principles.
2.
A
small
employer
carrier
or
organized
delivery
system
shall
file
each
March
1
with
the
commissioner
or
the
director
of
public
health
an
actuarial
certification
that
the
small
employer
carrier
or
organized
delivery
system
is
in
compliance
with
this
section
and
that
the
rating
methods
of
the
small
employer
carrier
or
organized
delivery
system
are
actuarially
sound.
A
copy
of
the
certification
shall
be
retained
by
the
small
employer
carrier
or
organized
delivery
system
at
its
principal
place
of
business.
3.
A
small
employer
carrier
or
organized
delivery
system
shall
make
the
information
and
documentation
described
in
subsection
1
available
to
the
commissioner
or
the
director
of
public
health
upon
request.
The
information
is
not
a
public
record
or
otherwise
subject
to
disclosure
under
chapter
22
,
and
is
considered
proprietary
and
trade
secret
information
and
is
not
subject
to
disclosure
by
the
commissioner
or
the
director
of
public
health
to
persons
outside
of
the
division
or
department
except
as
agreed
to
by
the
small
employer
carrier
or
organized
delivery
system
or
as
ordered
by
a
court
of
competent
jurisdiction.
Sec.
42.
Section
513B.9A,
subsection
1,
unnumbered
paragraph
1,
Code
2017,
is
amended
to
read
as
follows:
A
carrier
or
organized
delivery
system
offering
group
health
insurance
coverage
shall
not
establish
rules
for
eligibility,
including
continued
eligibility,
of
an
individual
to
enroll
under
the
terms
of
the
coverage
based
on
any
of
the
following
health
status-related
factors
in
relation
to
the
individual
or
a
dependent
of
the
individual:
Sec.
43.
Section
513B.9A,
subsection
4,
paragraph
a,
Code
House
File
393,
p.
21
2017,
is
amended
to
read
as
follows:
a.
A
carrier
or
organized
delivery
system
offering
health
insurance
coverage
shall
not
require
an
individual,
as
a
condition
of
enrollment
or
continued
enrollment
under
the
coverage,
to
pay
a
premium
or
contribution
which
is
greater
than
a
premium
or
contribution
for
a
similarly
situated
individual
enrolled
in
the
coverage
on
the
basis
of
a
health
status-related
factor
in
relation
to
the
individual
or
to
a
dependent
of
an
individual
enrolled
under
the
coverage.
Sec.
44.
Section
513B.9A,
subsection
4,
paragraph
b,
subparagraph
(2),
Code
2017,
is
amended
to
read
as
follows:
(2)
Prevent
a
carrier
or
organized
delivery
system
offering
group
health
insurance
coverage
from
establishing
premium
discounts
or
rebates
or
modifying
otherwise
applicable
copayments
or
deductibles
in
return
for
adherence
to
programs
of
health
promotion
and
disease
prevention.
Sec.
45.
Section
513B.10,
Code
2017,
is
amended
to
read
as
follows:
513B.10
Availability
of
coverage.
1.
a.
A
carrier
or
an
organized
delivery
system
that
offers
health
insurance
coverage
in
the
small
group
market
shall
accept
every
small
employer
that
applies
for
health
insurance
coverage
and
shall
accept
for
enrollment
under
such
coverage
every
eligible
individual
who
applies
for
enrollment
during
the
period
in
which
the
individual
first
becomes
eligible
to
enroll
under
the
terms
of
the
health
insurance
coverage
and
shall
not
place
any
restriction
which
is
inconsistent
with
eligibility
rules
established
under
this
chapter
.
b.
A
carrier
or
organized
delivery
system
that
offers
health
insurance
coverage
in
the
small
group
market
through
a
network
plan
may
do
either
of
the
following:
(1)
Limit
employers
that
may
apply
for
such
coverage
to
those
with
eligible
individuals
who
live,
work,
or
reside
in
the
service
area
for
such
network
plan.
(2)
Deny
such
coverage
to
such
employers
within
the
service
area
of
such
plan
if
the
carrier
or
organized
delivery
system
has
demonstrated
to
the
applicable
state
authority
both
of
the
following:
(a)
The
carrier
or
organized
delivery
system
will
not
have
House
File
393,
p.
22
the
capacity
to
deliver
services
adequately
to
enrollees
of
any
additional
groups
because
of
its
obligations
to
existing
group
contract
holders
and
enrollees.
(b)
The
carrier
or
organized
delivery
system
is
applying
this
subparagraph
uniformly
to
all
employers
without
regard
to
the
claims
experience
of
those
employers
and
their
employees
and
their
dependents,
or
any
health
status-related
factor
relating
to
such
employees
or
dependents.
c.
A
carrier
or
organized
delivery
system
,
upon
denying
health
insurance
coverage
in
any
service
area
pursuant
to
paragraph
“b”
,
subparagraph
(2),
shall
not
offer
coverage
in
the
small
group
market
within
such
service
area
for
a
period
of
one
hundred
eighty
days
after
the
date
such
coverage
is
denied.
d.
A
carrier
or
organized
delivery
system
may
deny
health
insurance
coverage
in
the
small
group
market
if
the
issuer
has
demonstrated
to
the
commissioner
or
director
of
public
health
both
of
the
following:
(1)
The
carrier
or
organized
delivery
system
does
not
have
the
financial
reserves
necessary
to
underwrite
additional
coverage.
(2)
The
carrier
or
organized
delivery
system
is
applying
the
provisions
of
this
paragraph
uniformly
to
all
employers
in
the
small
group
market
in
this
state
consistent
with
state
law
and
without
regard
to
the
claims
experience
of
those
employers
and
the
employees
and
dependents
of
such
employers,
or
any
health
status-related
factor
relating
to
such
employees
and
their
dependents.
e.
A
carrier
or
organized
delivery
system
,
upon
denying
health
insurance
coverage
pursuant
to
paragraph
“d”
,
shall
not
offer
coverage
in
connection
with
health
insurance
coverages
in
the
small
group
market
in
this
state
for
a
period
of
one
hundred
eighty
days
after
the
date
such
coverage
is
denied
or
until
the
carrier
or
organized
delivery
system
has
demonstrated
to
the
commissioner
or
director
of
public
health
that
the
carrier
or
organized
delivery
system
has
sufficient
financial
reserves
to
underwrite
additional
coverage,
whichever
is
later.
The
commissioner
or
director
may
provide
for
the
application
of
this
paragraph
on
a
service
area-specific
basis.
f.
Paragraph
“a”
shall
not
be
construed
to
preclude
House
File
393,
p.
23
a
carrier
or
organized
delivery
system
from
establishing
employer
contribution
rules
or
group
participation
rules
for
the
offering
of
health
insurance
coverage
in
the
small
group
market.
2.
A
carrier
or
organized
delivery
system
,
subject
to
subsection
1
,
shall
issue
health
insurance
coverage
to
an
eligible
small
employer
that
applies
for
the
coverage
and
agrees
to
make
the
required
premium
payments
and
satisfy
the
other
reasonable
provisions
of
the
health
insurance
coverage
not
inconsistent
with
this
chapter
.
A
carrier
or
organized
delivery
system
is
not
required
to
issue
health
insurance
coverage
to
a
self-employed
individual
who
is
covered
by,
or
is
eligible
for
coverage
under,
health
insurance
coverage
offered
by
an
employer.
3.
Health
insurance
coverage
for
small
employers
shall
satisfy
all
of
the
following:
a.
A
carrier
or
organized
delivery
system
offering
group
health
insurance
coverage,
with
respect
to
a
participant
or
beneficiary,
may
impose
a
preexisting
condition
exclusion
only
as
follows:
(1)
The
exclusion
relates
to
a
condition,
whether
physical
or
mental,
regardless
of
the
cause
of
the
condition,
for
which
medical
advice,
diagnosis,
care,
or
treatment
was
recommended
or
received
within
the
six-month
period
ending
on
the
enrollment
date.
However,
genetic
information
shall
not
be
treated
as
a
condition
under
this
subparagraph
in
the
absence
of
a
diagnosis
of
the
condition
related
to
such
information.
(2)
The
exclusion
extends
for
a
period
of
not
more
than
twelve
months,
or
eighteen
months
in
the
case
of
a
late
enrollee,
after
the
enrollment
date.
(3)
The
period
of
any
such
preexisting
condition
exclusion
is
reduced
by
the
aggregate
of
the
periods
of
creditable
coverage
applicable
to
the
participant
or
beneficiary
as
of
the
enrollment
date.
b.
A
carrier
or
organized
delivery
system
offering
group
health
insurance
coverage
shall
not
impose
any
preexisting
condition
exclusion
as
follows:
(1)
In
the
case
of
a
child
who
is
adopted
or
placed
for
adoption
before
attaining
eighteen
years
of
age
and
who,
as
of
House
File
393,
p.
24
the
last
day
of
the
thirty-day
period
beginning
on
the
date
of
the
adoption
or
placement
for
adoption,
is
covered
under
creditable
coverage.
This
subparagraph
shall
not
apply
to
coverage
before
the
date
of
such
adoption
or
placement
for
adoption.
(2)
In
the
case
of
an
individual
who,
as
of
the
last
day
of
the
thirty-day
period
beginning
with
the
date
of
birth,
is
covered
under
creditable
coverage.
(3)
Relating
to
pregnancy
as
a
preexisting
condition.
c.
A
carrier
or
organized
delivery
system
shall
waive
any
waiting
period
applicable
to
a
preexisting
condition
exclusion
or
limitation
period
with
respect
to
particular
services
under
health
insurance
coverage
for
the
period
of
time
an
individual
was
covered
by
creditable
coverage,
provided
that
the
creditable
coverage
was
continuous
to
a
date
not
more
than
sixty-three
days
prior
to
the
effective
date
of
the
new
coverage.
Any
period
that
an
individual
is
in
a
waiting
period
for
any
coverage
under
group
health
insurance
coverage,
or
is
in
an
affiliation
period,
shall
not
be
taken
into
account
in
determining
the
period
of
continuous
coverage.
A
health
maintenance
organization
that
does
not
use
preexisting
condition
limitations
in
any
of
its
health
insurance
coverage
may
impose
an
affiliation
period.
For
purposes
of
this
section
,
“affiliation
period”
means
a
period
of
time
not
to
exceed
sixty
days
for
new
entrants
and
not
to
exceed
ninety
days
for
late
enrollees
during
which
no
premium
shall
be
collected
and
coverage
issued
is
not
effective,
so
long
as
the
affiliation
period
is
applied
uniformly,
without
regard
to
any
health
status-related
factors.
This
paragraph
does
not
preclude
application
of
a
waiting
period
applicable
to
all
new
enrollees
under
the
health
insurance
coverage,
provided
that
any
carrier
or
organized
delivery
system-imposed
carrier-imposed
waiting
period
is
no
longer
than
sixty
days
and
is
used
in
lieu
of
a
preexisting
condition
exclusion.
d.
Health
insurance
coverage
may
exclude
coverage
for
late
enrollees
for
preexisting
conditions
for
a
period
not
to
exceed
eighteen
months.
e.
(1)
Requirements
used
by
a
carrier
or
organized
delivery
system
in
determining
whether
to
provide
coverage
to
a
small
House
File
393,
p.
25
employer
shall
be
applied
uniformly
among
all
small
employers
applying
for
coverage
or
receiving
coverage
from
the
carrier
or
organized
delivery
system
.
(2)
In
applying
minimum
participation
requirements
with
respect
to
a
small
employer,
a
carrier
or
organized
delivery
system
shall
not
consider
employees
or
dependents
who
have
other
creditable
coverage
in
determining
whether
the
applicable
percentage
of
participation
is
met.
(3)
A
carrier
or
organized
delivery
system
shall
not
increase
any
requirement
for
minimum
employee
participation
or
modify
any
requirement
for
minimum
employer
contribution
applicable
to
a
small
employer
at
any
time
after
the
small
employer
has
been
accepted
for
coverage.
f.
(1)
If
a
carrier
or
organized
delivery
system
offers
coverage
to
a
small
employer,
the
carrier
or
organized
delivery
system
shall
offer
coverage
to
all
eligible
employees
of
the
small
employer
and
the
employees’
dependents.
A
carrier
or
organized
delivery
system
shall
not
offer
coverage
to
only
certain
individuals
or
dependents
in
a
small
employer
group
or
to
only
part
of
the
group.
(2)
Except
as
provided
under
paragraphs
“a”
and
“d”
,
a
carrier
or
organized
delivery
system
shall
not
modify
health
insurance
coverage
with
respect
to
a
small
employer
or
any
eligible
employee
or
dependent
through
riders,
endorsements,
or
other
means,
to
restrict
or
exclude
coverage
or
benefits
for
certain
diseases,
medical
conditions,
or
services
otherwise
covered
by
the
health
insurance
coverage.
g.
A
carrier
or
organized
delivery
system
offering
coverage
through
a
network
plan
shall
not
be
required
to
offer
coverage
or
accept
applications
pursuant
to
subsection
1
with
respect
to
a
small
employer
where
any
of
the
following
apply
applies
:
(1)
The
small
employer
does
not
have
eligible
individuals
who
live,
work,
or
reside
in
the
service
area
for
the
network
plan.
(2)
The
small
employer
does
have
eligible
individuals
who
live,
work,
or
reside
in
the
service
area
for
the
network
plan,
but
the
carrier
or
organized
delivery
system
,
if
required,
has
demonstrated
to
the
commissioner
or
the
director
of
public
health
that
it
will
not
have
the
capacity
to
deliver
services
House
File
393,
p.
26
adequately
to
enrollees
of
any
additional
groups
because
of
its
obligations
to
existing
group
contract
holders
and
enrollees
and
that
it
is
applying
the
requirements
of
this
lettered
paragraph
uniformly
to
all
employers
without
regard
to
the
claims
experience
of
those
employers
and
their
employees
and
the
employees’
dependents,
or
any
health
status-related
factor
relating
to
such
employees
and
dependents.
(3)
A
carrier
or
organized
delivery
system
,
upon
denying
health
insurance
coverage
in
a
service
area
pursuant
to
subparagraph
(2),
shall
not
offer
coverage
in
the
small
employer
market
within
such
service
area
for
a
period
of
one
hundred
eighty
days
after
the
coverage
is
denied.
4.
A
carrier
or
organized
delivery
system
shall
not
be
required
to
offer
coverage
to
small
employers
pursuant
to
subsection
1
for
any
period
of
time
where
the
commissioner
or
director
of
public
health
determines
that
the
acceptance
of
the
offers
by
small
employers
in
accordance
with
subsection
1
would
place
the
carrier
or
organized
delivery
system
in
a
financially
impaired
condition.
5.
A
carrier
or
organized
delivery
system
shall
not
be
required
to
provide
coverage
to
small
employers
pursuant
to
subsection
1
if
the
carrier
or
organized
delivery
system
elects
not
to
offer
new
coverage
to
small
employers
in
this
state.
However,
a
carrier
or
organized
delivery
system
that
elects
not
to
offer
new
coverage
to
small
employers
under
this
subsection
shall
be
allowed
to
maintain
its
existing
policies
in
the
state,
subject
to
the
requirements
of
section
513B.5
.
6.
A
carrier
or
organized
delivery
system
that
elects
not
to
offer
new
coverage
to
small
employers
pursuant
to
subsection
5
shall
provide
notice
to
the
commissioner
or
director
of
public
health
and
is
prohibited
from
writing
new
business
in
the
small
employer
market
in
this
state
for
a
period
of
five
years
from
the
date
of
notice
to
the
commissioner
or
director
.
Sec.
46.
Section
513C.3,
subsection
5,
Code
2017,
is
amended
to
read
as
follows:
5.
“Carrier”
means
any
entity
that
provides
individual
health
benefit
plans
in
this
state.
For
purposes
of
this
chapter
,
carrier
includes
an
insurance
company,
a
group
hospital
or
medical
service
corporation,
a
fraternal
benefit
House
File
393,
p.
27
society,
a
health
maintenance
organization,
and
any
other
entity
providing
an
individual
plan
of
health
insurance
or
health
benefits
subject
to
state
insurance
regulation.
“Carrier”
does
not
include
an
organized
delivery
system.
Sec.
47.
Section
513C.3,
subsection
7,
Code
2017,
is
amended
by
striking
the
subsection.
Sec.
48.
Section
513C.3,
subsection
9,
Code
2017,
is
amended
to
read
as
follows:
9.
“Established
service
area”
means
a
geographic
area,
as
approved
by
the
commissioner
and
based
upon
the
carrier’s
certificate
of
authority
to
transact
business
in
this
state,
within
which
the
carrier
is
authorized
to
provide
coverage
or
a
geographic
area,
as
approved
by
the
director
and
based
upon
the
organized
delivery
system’s
license
to
transact
business
in
this
state,
within
which
the
organized
delivery
system
is
authorized
to
provide
coverage
.
Sec.
49.
Section
513C.3,
subsection
12,
Code
2017,
is
amended
by
striking
the
subsection.
Sec.
50.
Section
513C.3,
subsection
15,
paragraph
a,
subparagraph
(3),
Code
2017,
is
amended
by
striking
the
subparagraph.
Sec.
51.
Section
513C.3,
subsection
18,
Code
2017,
is
amended
to
read
as
follows:
18.
“Restricted
network
provision”
means
a
provision
of
an
individual
health
benefit
plan
that
conditions
the
payment
of
benefits,
in
whole
or
in
part,
on
the
use
of
health
care
providers
that
have
entered
into
a
contractual
arrangement
with
the
carrier
or
the
organized
delivery
system
to
provide
health
care
services
to
covered
individuals.
Sec.
52.
Section
513C.5,
subsection
1,
unnumbered
paragraph
1,
Code
2017,
is
amended
to
read
as
follows:
Premium
rates
for
any
block
of
individual
health
benefit
plan
business
issued
on
or
after
January
1,
1996,
or
the
date
rules
are
adopted
by
the
commissioner
of
insurance
and
the
director
of
public
health
and
become
effective,
whichever
date
is
later,
by
a
carrier
subject
to
this
chapter
shall
be
limited
to
the
composite
effect
of
allocating
costs
among
the
following:
Sec.
53.
Section
513C.6,
Code
2017,
is
amended
to
read
as
House
File
393,
p.
28
follows:
513C.6
Provisions
on
renewability
of
coverage.
1.
An
individual
health
benefit
plan
subject
to
this
chapter
is
renewable
with
respect
to
an
eligible
individual
or
dependents,
at
the
option
of
the
individual,
except
for
one
or
more
of
the
following
reasons:
a.
The
individual
fails
to
pay,
or
to
make
timely
payment
of,
premiums
or
contributions
pursuant
to
the
terms
of
the
individual
health
benefit
plan.
b.
The
individual
performs
an
act
or
practice
constituting
fraud
or
makes
an
intentional
misrepresentation
of
a
material
fact
under
the
terms
of
the
individual
health
benefit
plan.
c.
A
decision
by
the
individual
carrier
or
organized
delivery
system
to
discontinue
offering
a
particular
type
of
individual
health
benefit
plan
in
the
state’s
individual
insurance
market.
An
individual
health
benefit
plan
may
be
discontinued
by
the
carrier
or
organized
delivery
system
in
that
market
with
the
approval
of
the
commissioner
or
the
director
and
only
if
the
carrier
or
organized
delivery
system
does
all
of
the
following:
(1)
Provides
advance
notice
of
its
decision
to
discontinue
such
plan
to
the
commissioner
or
director
.
Notice
to
the
commissioner
or
director
,
at
a
minimum,
shall
be
no
less
than
three
days
prior
to
the
notice
provided
for
in
subparagraph
(2)
to
affected
individuals.
(2)
Provides
notice
of
its
decision
not
to
renew
such
plan
to
all
affected
individuals
no
less
than
ninety
days
prior
to
the
nonrenewal
date
of
any
discontinued
individual
health
benefit
plans.
(3)
Offers
to
each
individual
of
the
discontinued
plan
the
option
to
purchase
any
other
health
plan
currently
offered
by
the
carrier
or
organized
delivery
system
to
individuals
in
this
state.
(4)
Acts
uniformly
in
opting
to
discontinue
the
plan
and
in
offering
the
option
under
subparagraph
(3),
without
regard
to
the
claims
experience
of
any
affected
eligible
individual
or
beneficiary
under
the
discontinued
plan
or
to
a
health
status-related
factor
relating
to
any
covered
individuals
or
beneficiaries
who
may
become
eligible
for
the
coverage.
House
File
393,
p.
29
d.
A
decision
by
the
carrier
or
organized
delivery
system
to
discontinue
offering
and
to
cease
to
renew
all
of
its
individual
health
benefit
plans
delivered
or
issued
for
delivery
to
individuals
in
this
state.
A
carrier
or
organized
delivery
system
making
such
decision
shall
do
all
of
the
following:
(1)
Provide
advance
notice
of
its
decision
to
discontinue
such
plan
to
the
commissioner
or
director
.
Notice
to
the
commissioner
or
director
,
at
a
minimum,
shall
be
no
less
than
three
days
prior
to
the
notice
provided
for
in
subparagraph
(2)
to
affected
individuals.
(2)
Provide
notice
of
its
decision
not
to
renew
such
plan
to
all
individuals
and
to
the
commissioner
or
director
in
each
state
in
which
an
individual
under
the
discontinued
plan
is
known
to
reside,
no
less
than
one
hundred
eighty
days
prior
to
the
nonrenewal
of
the
plan.
e.
The
commissioner
or
director
finds
that
the
continuation
of
the
coverage
is
not
in
the
best
interests
of
the
individuals,
or
would
impair
the
carrier’s
or
organized
delivery
system’s
ability
to
meet
its
contractual
obligations.
2.
At
the
time
of
coverage
renewal,
a
carrier
or
organized
delivery
system
may
modify
the
health
insurance
coverage
for
a
policy
form
offered
to
individuals
in
the
individual
market
so
long
as
such
modification
is
consistent
with
state
law
and
effective
on
a
uniform
basis
among
all
individuals
with
that
policy
form.
3.
An
individual
carrier
or
organized
delivery
system
that
elects
not
to
renew
an
individual
health
benefit
plan
under
subsection
1
,
paragraph
“d”
,
shall
not
write
any
new
business
in
the
individual
market
in
this
state
for
a
period
of
five
years
after
the
date
of
notice
to
the
commissioner
or
director
.
4.
This
section
,
with
respect
to
a
carrier
or
organized
delivery
system
doing
business
in
one
established
geographic
service
area
of
the
state,
applies
only
to
such
carrier’s
or
organized
delivery
system’s
operations
in
that
service
area.
5.
A
carrier
or
organized
delivery
system
offering
coverage
through
a
network
plan
is
not
required
to
renew
or
continue
in
force
coverage
or
to
accept
applications
from
an
individual
who
no
longer
resides
or
lives
in,
or
is
no
longer
employed
in,
House
File
393,
p.
30
the
service
area
of
such
carrier
or
organized
delivery
system
,
or
no
longer
resides
or
lives
in,
or
is
no
longer
employed
in,
a
service
area
for
which
the
carrier
is
authorized
to
do
business,
but
only
if
coverage
is
not
offered
or
terminated
uniformly
without
regard
to
health
status-related
factors
of
a
covered
individual.
6.
A
carrier
or
organized
delivery
system
offering
coverage
through
a
bona
fide
association
is
not
required
to
renew
or
continue
in
force
coverage
or
to
accept
applications
from
an
individual
through
an
association
if
the
membership
of
the
individual
in
the
association
on
which
the
basis
of
coverage
is
provided
ceases,
but
only
if
the
coverage
is
not
offered
or
terminated
under
this
paragraph
uniformly
without
regard
to
health
status-related
factors
of
a
covered
individual.
7.
An
individual
who
has
coverage
as
a
dependent
under
a
basic
or
standard
health
benefit
plan
may,
when
that
individual
is
no
longer
a
dependent
under
such
coverage,
elect
to
continue
coverage
under
the
basic
or
standard
health
benefit
plan
if
the
individual
so
elects
immediately
upon
termination
of
the
coverage
under
which
the
individual
was
covered
as
a
dependent.
Sec.
54.
Section
513C.7,
subsection
1,
Code
2017,
is
amended
to
read
as
follows:
1.
a.
(1)
A
carrier
shall
file
with
the
commissioner,
in
a
form
and
manner
prescribed
by
the
commissioner,
the
basic
or
standard
health
benefit
plan.
A
basic
or
standard
health
benefit
plan
filed
pursuant
to
this
paragraph
may
be
used
by
a
carrier
beginning
thirty
days
after
it
is
filed
unless
the
commissioner
disapproves
of
its
use.
(2)
b.
The
commissioner
may
at
any
time,
after
providing
notice
and
an
opportunity
for
a
hearing
to
the
carrier,
disapprove
the
continued
use
by
a
carrier
of
a
basic
or
standard
health
benefit
plan
on
the
grounds
that
the
plan
does
not
meet
the
requirements
of
this
chapter
.
b.
(1)
An
organized
delivery
system
shall
file
with
the
director,
in
a
form
and
manner
prescribed
by
the
director,
the
basic
or
standard
health
benefit
plan
to
be
used
by
the
organized
delivery
system.
A
basic
or
standard
health
benefit
plan
filed
pursuant
to
this
paragraph
may
be
used
by
the
organized
delivery
system
beginning
thirty
days
after
it
is
House
File
393,
p.
31
filed
unless
the
director
disapproves
of
its
use.
(2)
The
director
may
at
any
time,
after
providing
notice
and
an
opportunity
for
a
hearing
to
the
organized
delivery
system,
disapprove
the
continued
use
by
an
organized
delivery
system
of
a
basic
or
standard
health
benefit
plan
on
the
grounds
that
the
plan
does
not
meet
the
requirements
of
this
chapter
.
Sec.
55.
Section
513C.7,
subsection
3,
Code
2017,
is
amended
to
read
as
follows:
3.
A
carrier
or
an
organized
delivery
system
shall
not
modify
a
basic
or
standard
health
benefit
plan
with
respect
to
an
individual
or
dependent
through
riders,
endorsements,
or
other
means
to
restrict
or
exclude
coverage
for
certain
diseases
or
medical
conditions
otherwise
covered
by
the
health
benefit
plan.
Sec.
56.
Section
513C.9,
subsections
1,
2,
3,
6,
and
8,
Code
2017,
are
amended
to
read
as
follows:
1.
A
carrier
,
an
organized
delivery
system,
or
an
agent
shall
not
do
either
of
the
following:
a.
Encourage
or
direct
individuals
to
refrain
from
filing
an
application
for
coverage
with
the
carrier
or
the
organized
delivery
system
because
of
the
health
status,
claims
experience,
industry,
occupation,
or
geographic
location
of
the
individuals.
b.
Encourage
or
direct
individuals
to
seek
coverage
from
another
carrier
or
another
organized
delivery
system
because
of
the
health
status,
claims
experience,
industry,
occupation,
or
geographic
location
of
the
individuals.
2.
Subsection
1
,
paragraph
“a”
,
shall
not
apply
with
respect
to
information
provided
by
a
carrier
or
an
organized
delivery
system
or
an
agent
to
an
individual
regarding
the
established
geographic
service
area
of
the
carrier
or
the
organized
delivery
system,
or
the
restricted
network
provision
of
the
carrier
or
the
organized
delivery
system
.
3.
A
carrier
or
an
organized
delivery
system
shall
not,
directly
or
indirectly,
enter
into
any
contract,
agreement,
or
arrangement
with
an
agent
that
provides
for,
or
results
in,
the
compensation
paid
to
an
agent
for
a
sale
of
a
basic
or
standard
health
benefit
plan
to
vary
because
of
the
health
status
or
permitted
rating
characteristics
of
the
individual
or
the
House
File
393,
p.
32
individual’s
dependents.
6.
Denial
by
a
carrier
or
an
organized
delivery
system
of
an
application
for
coverage
from
an
individual
shall
be
in
writing
and
shall
state
the
reason
or
reasons
for
the
denial.
8.
If
a
carrier
or
an
organized
delivery
system
enters
into
a
contract,
agreement,
or
other
arrangement
with
a
third-party
administrator
to
provide
administrative,
marketing,
or
other
services
related
to
the
offering
of
individual
health
benefit
plans
in
this
state,
the
third-party
administrator
is
subject
to
this
section
as
if
it
were
a
carrier
or
an
organized
delivery
system
.
Sec.
57.
Section
513C.10,
subsection
1,
paragraph
a,
Code
2017,
is
amended
to
read
as
follows:
a.
All
persons
that
provide
health
benefit
plans
in
this
state
including
insurers
providing
accident
and
sickness
insurance
under
chapter
509
,
514
,
or
514A
,
whether
on
an
individual
or
group
basis;
fraternal
benefit
societies
providing
hospital,
medical,
or
nursing
benefits
under
chapter
512B
;
and
health
maintenance
organizations,
organized
delivery
systems,
other
entities
providing
health
insurance
or
health
benefits
subject
to
state
insurance
regulation,
and
all
other
insurers
as
designated
by
the
board
of
directors
of
the
Iowa
comprehensive
health
insurance
association
with
the
approval
of
the
commissioner
shall
be
members
of
the
association.
Sec.
58.
Section
513C.10,
subsection
2,
paragraph
a,
Code
2017,
is
amended
to
read
as
follows:
a.
Rates
for
basic
and
standard
coverages
as
provided
in
this
chapter
shall
be
determined
by
each
carrier
or
organized
delivery
system
as
the
product
of
a
basic
and
standard
factor
and
the
lowest
rate
available
for
issuance
by
that
carrier
or
organized
delivery
system
adjusted
for
rating
characteristics
and
benefits.
Basic
and
standard
factors
shall
be
established
annually
by
the
Iowa
comprehensive
health
insurance
association
board
with
the
approval
of
the
commissioner.
Multiple
basic
and
standard
factors
for
a
distinct
grouping
of
basic
and
standard
policies
may
be
established.
A
basic
and
standard
factor
is
limited
to
a
minimum
value
defined
as
the
ratio
of
the
average
of
the
lowest
rate
available
for
issuance
and
the
maximum
rate
allowable
by
law
divided
by
the
lowest
rate
House
File
393,
p.
33
available
for
issuance.
A
basic
and
standard
factor
is
limited
to
a
maximum
value
defined
as
the
ratio
of
the
maximum
rate
allowable
by
law
divided
by
the
lowest
rate
available
for
issuance.
The
maximum
rate
allowable
by
law
and
the
lowest
rate
available
for
issuance
is
determined
based
on
the
rate
restrictions
under
this
chapter
.
For
policies
written
after
January
1,
2002,
rates
for
the
basic
and
standard
coverages
as
provided
in
this
chapter
shall
be
calculated
using
the
basic
and
standard
factors
and
shall
be
no
lower
than
the
maximum
rate
allowable
by
law.
However,
to
maintain
assessable
loss
assessments
at
or
below
one
percent
of
total
health
insurance
premiums
or
payments
as
determined
in
accordance
with
subsection
6
,
the
Iowa
comprehensive
health
insurance
association
board
with
the
approval
of
the
commissioner
may
increase
the
value
for
any
basic
and
standard
factor
greater
than
the
maximum
value.
Sec.
59.
Section
513C.10,
subsections
3,
4,
7,
8,
9,
and
10,
Code
2017,
are
amended
to
read
as
follows:
3.
Following
the
close
of
each
calendar
year,
the
association,
in
conjunction
with
the
commissioner,
shall
require
each
carrier
or
organized
delivery
system
to
report
the
amount
of
earned
premiums
and
the
associated
paid
losses
for
all
basic
and
standard
plans
issued
by
the
carrier
or
organized
delivery
system
.
The
reporting
of
these
amounts
must
be
certified
by
an
officer
of
the
carrier
or
organized
delivery
system
.
4.
The
board
shall
develop
procedures
and
assessment
mechanisms
and
make
assessments
and
distributions
as
required
to
equalize
the
individual
carrier
and
organized
delivery
system
gains
or
losses
so
that
each
carrier
or
organized
delivery
system
receives
the
same
ratio
of
paid
claims
to
ninety
percent
of
earned
premiums
as
the
aggregate
of
all
basic
and
standard
plans
insured
by
all
carriers
and
organized
delivery
systems
in
the
state.
7.
The
board
shall
develop
procedures
for
distributing
the
assessable
loss
assessments
to
each
carrier
and
organized
delivery
system
in
proportion
to
the
carrier’s
and
organized
delivery
system’s
respective
share
of
premium
for
basic
and
standard
plans
to
the
statewide
total
premium
for
all
basic
and
House
File
393,
p.
34
standard
plans.
8.
The
board
shall
ensure
that
procedures
for
collecting
and
distributing
assessments
are
as
efficient
as
possible
for
carriers
and
organized
delivery
systems
.
The
board
may
establish
procedures
which
combine,
or
offset,
the
assessment
from,
and
the
distribution
due
to,
a
carrier
or
organized
delivery
system
.
9.
A
carrier
or
an
organized
delivery
system
may
petition
the
association
board
to
seek
remedy
from
writing
a
significantly
disproportionate
share
of
basic
and
standard
policies
in
relation
to
total
premiums
written
in
this
state
for
health
benefit
plans.
Upon
a
finding
that
a
carrier
or
organized
delivery
system
has
written
a
disproportionate
share,
the
board
may
agree
to
compensate
the
carrier
or
organized
delivery
system
either
by
paying
to
the
carrier
or
organized
delivery
system
an
additional
fee
not
to
exceed
two
percent
of
earned
premiums
from
basic
and
standard
policies
for
that
carrier
or
organized
delivery
system
or
by
petitioning
the
commissioner
or
director,
as
appropriate,
for
remedy.
10.
a.
The
commissioner,
upon
a
finding
that
the
acceptance
of
the
offer
of
basic
and
standard
coverage
by
individuals
pursuant
to
this
chapter
would
place
the
carrier
in
a
financially
impaired
condition,
shall
not
require
the
carrier
to
offer
coverage
or
accept
applications
for
any
period
of
time
the
financial
impairment
is
deemed
to
exist.
b.
The
director,
upon
a
finding
that
the
acceptance
of
the
offer
of
basic
and
standard
coverage
by
individuals
pursuant
to
this
chapter
would
place
the
organized
delivery
system
in
a
financially
impaired
condition,
shall
not
require
the
organized
delivery
system
to
offer
coverage
or
accept
applications
for
any
period
of
time
the
financial
impairment
is
deemed
to
exist.
Sec.
60.
Section
514A.3B,
subsection
3,
paragraph
k,
Code
2017,
is
amended
by
striking
the
paragraph.
Sec.
61.
Section
514B.25A,
Code
2017,
is
amended
to
read
as
follows:
514B.25A
Insolvency
protection
——
assessment.
1.
Upon
a
health
maintenance
organization
or
organized
delivery
system
authorized
to
do
business
in
this
state
and
licensed
by
the
director
of
public
health
being
declared
House
File
393,
p.
35
insolvent
by
the
district
court,
the
commissioner
may
levy
an
assessment
on
each
health
maintenance
organization
or
organized
delivery
system
doing
business
in
this
state
and
licensed
by
the
director
of
public
health,
as
applicable
,
to
pay
claims
for
uncovered
expenditures
for
enrollees.
The
commissioner
shall
not
assess
an
amount
in
any
one
calendar
year
which
is
more
than
two
percent
of
the
aggregate
premium
written
by
each
health
maintenance
organization
or
organized
delivery
system
.
2.
The
commissioner
may
use
funds
obtained
through
an
assessment
under
subsection
1
to
pay
claims
for
uncovered
expenditures
for
enrollees
of
an
insolvent
health
maintenance
organization
or
organized
delivery
system
and
administrative
costs.
The
commissioner,
by
rule,
may
prescribe
the
time,
manner,
and
form
for
filing
claims
under
this
section
.
The
commissioner
may
require
claims
to
be
allowed
by
an
ancillary
receiver
or
the
domestic
receiver
or
liquidator.
3.
a.
A
receiver
or
liquidator
of
an
insolvent
health
maintenance
organization
or
organized
delivery
system
shall
allow
a
claim
in
the
proceeding
in
an
amount
equal
to
uncovered
expenditures
and
administrative
costs
paid
under
this
section
.
b.
A
person
receiving
benefits
under
this
section
for
uncovered
expenditures
is
deemed
to
have
assigned
the
rights
under
the
covered
health
care
plan
certificates
to
the
commissioner
to
the
extent
of
the
benefits
received.
The
commissioner
may
require
an
assignment
of
such
rights
by
a
payee,
enrollee,
or
beneficiary,
to
the
commissioner
as
a
condition
precedent
to
the
receipt
of
such
benefits.
The
commissioner
is
subrogated
to
these
rights
against
the
assets
of
the
insolvent
health
maintenance
organization
or
organized
delivery
system
that
are
held
by
a
receiver
or
liquidator
of
a
foreign
jurisdiction.
c.
The
assigned
subrogation
rights
of
the
commissioner
and
allowed
claims
under
this
subsection
have
the
same
priority
against
the
assets
of
the
insolvent
health
maintenance
organization
or
organized
delivery
system
as
those
claims
of
persons
entitled
to
receive
benefits
under
this
section
or
for
similar
expenses
in
the
receivership
or
liquidation.
4.
If
funds
assessed
under
subsection
1
are
unused
following
the
completion
of
the
liquidation
of
an
insolvent
House
File
393,
p.
36
health
maintenance
organization
or
organized
delivery
system
,
the
commissioner
shall
distribute
the
remaining
amounts,
if
such
amounts
are
not
de
minimis,
to
the
health
maintenance
organizations
or
organized
delivery
systems
that
were
assessed.
5.
The
aggregate
coverage
of
uncovered
expenditures
under
this
section
shall
not
exceed
three
hundred
thousand
dollars
with
respect
to
one
individual.
Continuation
of
coverage
shall
cease
after
the
lesser
of
one
year
after
the
health
maintenance
organization
or
organized
delivery
system
is
terminated
by
insolvency
or
the
remaining
term
of
the
contract.
The
commissioner
may
provide
continuation
of
coverage
on
a
reasonable
basis,
including,
but
not
limited
to,
continuation
of
the
health
maintenance
organization
or
organized
delivery
system
contract
or
substitution
of
indemnity
coverage
in
a
form
as
determined
by
the
commissioner.
6.
The
commissioner
may
waive
an
assessment
of
a
health
maintenance
organization
or
organized
delivery
system
if
such
organization
or
system
is
impaired
financially
or
would
be
impaired
financially
as
a
result
of
such
assessment.
A
health
maintenance
organization
or
organized
delivery
system
that
fails
to
pay
an
assessment
within
thirty
days
after
notice
of
the
assessment
is
subject
to
a
civil
forfeiture
of
not
more
than
one
thousand
dollars
for
each
day
the
failure
continues,
and
suspension
or
revocation
of
its
certificate
of
authority.
An
action
taken
by
the
commissioner
to
enforce
an
assessment
under
this
section
may
be
appealed
by
the
health
maintenance
organization
or
organized
delivery
system
pursuant
to
chapter
17A
.
Sec.
62.
Section
514C.10,
subsection
2,
paragraph
e,
Code
2017,
is
amended
by
striking
the
paragraph.
Sec.
63.
Section
514C.11,
Code
2017,
is
amended
to
read
as
follows:
514C.11
Services
provided
by
licensed
physician
assistants
and
licensed
advanced
registered
nurse
practitioners.
1.
Notwithstanding
section
514C.6
,
a
policy
or
contract
providing
for
third-party
payment
or
prepayment
of
health
or
medical
expenses
shall
include
a
provision
for
the
payment
of
necessary
medical
or
surgical
care
and
treatment
provided
by
a
physician
assistant
licensed
pursuant
to
chapter
148C
,
or
House
File
393,
p.
37
provided
by
an
advanced
registered
nurse
practitioner
licensed
pursuant
to
chapter
152
and
performed
within
the
scope
of
the
license
of
the
licensed
physician
assistant
or
the
licensed
advanced
registered
nurse
practitioner
if
the
policy
or
contract
would
pay
for
the
care
and
treatment
if
the
care
and
treatment
were
provided
by
a
person
engaged
in
the
practice
of
medicine
and
surgery
or
osteopathic
medicine
and
surgery
under
chapter
148
.
The
policy
or
contract
shall
provide
that
policyholders
and
subscribers
under
the
policy
or
contract
may
reject
the
coverage
for
services
which
may
be
provided
by
a
licensed
physician
assistant
or
licensed
advanced
registered
nurse
practitioner
if
the
coverage
is
rejected
for
all
providers
of
similar
services.
A
policy
or
contract
subject
to
this
section
shall
not
impose
a
practice
or
supervision
restriction
which
is
inconsistent
with
or
more
restrictive
than
the
restriction
already
imposed
by
law.
2.
This
section
applies
to
services
provided
under
a
policy
or
contract
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
state
on
or
after
July
1,
1996,
and
to
an
existing
policy
or
contract,
on
the
policy’s
or
contract’s
anniversary
or
renewal
date,
or
upon
the
expiration
of
the
applicable
collective
bargaining
contract,
if
any,
whichever
is
later.
This
section
does
not
apply
to
policyholders
or
subscribers
eligible
for
coverage
under
Tit.
XVIII
of
the
federal
Social
Security
Act
or
any
similar
coverage
under
a
state
or
federal
government
plan.
3.
For
the
purposes
of
this
section
,
third-party
payment
or
prepayment
includes
an
individual
or
group
policy
of
accident
or
health
insurance
or
individual
or
group
hospital
or
health
care
service
contract
issued
pursuant
to
chapter
509
,
514
,
or
514A
,
an
individual
or
group
health
maintenance
organization
contract
issued
and
regulated
under
chapter
514B
,
an
organized
delivery
system
contract
regulated
under
rules
adopted
by
the
director
of
public
health,
or
a
preferred
provider
organization
contract
regulated
pursuant
to
chapter
514F
.
4.
Nothing
in
this
section
shall
be
interpreted
to
require
an
individual
or
group
health
maintenance
organization
,
an
organized
delivery
system,
or
a
preferred
provider
organization
or
arrangement
to
provide
payment
or
prepayment
for
services
House
File
393,
p.
38
provided
by
a
licensed
physician
assistant
or
licensed
advanced
registered
nurse
practitioner
unless
the
physician
assistant’s
supervising
physician,
the
physician-physician
assistant
team,
the
advanced
registered
nurse
practitioner,
or
the
advanced
registered
nurse
practitioner’s
collaborating
physician
has
entered
into
a
contract
or
other
agreement
to
provide
services
with
the
individual
or
group
health
maintenance
organization
,
the
organized
delivery
system,
or
the
preferred
provider
organization
or
arrangement.
Sec.
64.
Section
514C.13,
subsection
1,
paragraph
h,
Code
2017,
is
amended
by
striking
the
paragraph.
Sec.
65.
Section
514C.13,
subsection
2,
Code
2017,
is
amended
to
read
as
follows:
2.
A
carrier
or
organized
delivery
system
which
offers
to
a
small
employer
a
limited
provider
network
plan
to
provide
health
care
services
or
benefits
to
the
small
employer’s
employees
shall
also
offer
to
the
small
employer
a
point
of
service
option
to
the
limited
provider
network
plan.
Sec.
66.
Section
514C.13,
subsection
3,
unnumbered
paragraph
1,
Code
2017,
is
amended
to
read
as
follows:
A
carrier
or
organized
delivery
system
which
offers
to
a
large
employer
a
limited
provider
network
plan
to
provide
health
care
services
or
benefits
to
the
large
employer’s
employees
shall
also
offer
to
the
large
employer
one
or
more
of
the
following:
Sec.
67.
Section
514C.14,
subsections
1
and
3,
Code
2017,
are
amended
to
read
as
follows:
1.
Except
as
provided
under
subsection
2
or
3
,
a
carrier,
as
defined
in
section
513B.2
,
an
organized
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158,
or
a
plan
established
pursuant
to
chapter
509A
for
public
employees,
which
terminates
its
contract
with
a
participating
health
care
provider,
shall
continue
to
provide
coverage
under
the
contract
to
a
covered
person
in
the
second
or
third
trimester
of
pregnancy
for
continued
care
from
such
health
care
provider.
Such
persons
may
continue
to
receive
such
treatment
or
care
through
postpartum
care
related
to
the
child
birth
and
delivery.
Payment
for
covered
benefits
and
benefit
levels
shall
be
according
to
the
terms
and
conditions
of
the
contract.
House
File
393,
p.
39
3.
A
carrier
,
organized
delivery
system,
or
a
plan
established
under
chapter
509A
,
which
terminates
the
contract
of
a
participating
health
care
provider
for
cause
shall
not
be
liable
to
pay
for
health
care
services
provided
by
the
health
care
provider
to
a
covered
person
following
the
date
of
termination.
Sec.
68.
Section
514C.15,
Code
2017,
is
amended
to
read
as
follows:
514C.15
Treatment
options.
A
carrier,
as
defined
in
section
513B.2
,
;
an
organized
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158,
and
licensed
by
the
director
of
public
health;
or
a
plan
established
pursuant
to
chapter
509A
for
public
employees,
shall
not
prohibit
a
participating
provider
from,
or
penalize
a
participating
provider
for,
doing
either
of
the
following:
1.
Discussing
treatment
options
with
a
covered
individual,
notwithstanding
the
carrier’s,
organized
delivery
system’s,
or
plan’s
position
on
such
treatment
option.
2.
Advocating
on
behalf
of
a
covered
individual
within
a
review
or
grievance
process
established
by
the
carrier
,
organized
delivery
system,
or
chapter
509A
plan,
or
established
by
a
person
contracting
with
the
carrier
,
organized
delivery
system,
or
chapter
509A
plan.
Sec.
69.
Section
514C.16,
subsection
1,
Code
2017,
is
amended
to
read
as
follows:
1.
A
carrier,
as
defined
in
section
513B.2
,
;
an
organized
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158,
and
licensed
by
the
director
of
public
health;
or
a
plan
established
pursuant
to
chapter
509A
for
public
employees,
which
provides
coverage
for
emergency
services,
is
responsible
for
charges
for
emergency
services
provided
to
a
covered
individual,
including
services
furnished
outside
any
contractual
provider
network
or
preferred
provider
network.
Coverage
for
emergency
services
is
subject
to
the
terms
and
conditions
of
the
health
benefit
plan
or
contract.
Sec.
70.
Section
514C.17,
subsections
1
and
3,
Code
2017,
are
amended
to
read
as
follows:
1.
Except
as
provided
under
subsection
2
or
3
,
if
a
carrier,
as
defined
in
section
513B.2
,
an
organized
delivery
system
House
File
393,
p.
40
authorized
under
1993
Iowa
Acts,
ch.
158,
or
a
plan
established
pursuant
to
chapter
509A
for
public
employees,
terminates
its
contract
with
a
participating
health
care
provider,
a
covered
individual
who
is
undergoing
a
specified
course
of
treatment
for
a
terminal
illness
or
a
related
condition,
with
the
recommendation
of
the
covered
individual’s
treating
physician
licensed
under
chapter
148
may
continue
to
receive
coverage
for
treatment
received
from
the
covered
individual’s
physician
for
the
terminal
illness
or
a
related
condition,
for
a
period
of
up
to
ninety
days.
Payment
for
covered
benefits
and
benefit
levels
shall
be
according
to
the
terms
and
conditions
of
the
contract.
3.
Notwithstanding
subsections
1
and
2
,
a
carrier
,
organized
delivery
system,
or
a
plan
established
under
chapter
509A
which
terminates
the
contract
of
a
participating
health
care
provider
for
cause
shall
not
be
required
to
cover
health
care
services
provided
by
the
health
care
provider
to
a
covered
person
following
the
date
of
termination.
Sec.
71.
Section
514C.18,
subsection
2,
paragraph
a,
subparagraph
(6),
Code
2017,
is
amended
by
striking
the
subparagraph.
Sec.
72.
Section
514C.19,
subsection
7,
paragraph
a,
subparagraph
(6),
Code
2017,
is
amended
by
striking
the
subparagraph.
Sec.
73.
Section
514C.20,
subsection
3,
paragraph
f,
Code
2017,
is
amended
by
striking
the
paragraph.
Sec.
74.
Section
514C.21,
subsection
2,
paragraph
d,
Code
2017,
is
amended
by
striking
the
paragraph.
Sec.
75.
Section
514C.22,
subsection
1,
unnumbered
paragraph
1,
Code
2017,
is
amended
to
read
as
follows:
Notwithstanding
the
uniformity
of
treatment
requirements
of
section
514C.6
,
a
group
policy,
contract,
or
plan
providing
for
third-party
payment
or
prepayment
of
health,
medical,
and
surgical
coverage
benefits
issued
by
a
carrier,
as
defined
in
section
513B.2
,
or
by
an
organized
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158,
shall
provide
coverage
benefits
for
treatment
of
a
biologically
based
mental
illness
if
either
of
the
following
is
satisfied:
Sec.
76.
Section
514C.22,
subsection
6,
Code
2017,
is
House
File
393,
p.
41
amended
to
read
as
follows:
6.
A
carrier
,
organized
delivery
system,
or
plan
established
pursuant
to
chapter
509A
may
manage
the
benefits
provided
through
common
methods
including,
but
not
limited
to,
providing
payment
of
benefits
or
providing
care
and
treatment
under
a
capitated
payment
system,
prospective
reimbursement
rate
system,
utilization
control
system,
incentive
system
for
the
use
of
least
restrictive
and
least
costly
levels
of
care,
a
preferred
provider
contract
limiting
choice
of
specific
providers,
or
any
other
system,
method,
or
organization
designed
to
assure
services
are
medically
necessary
and
clinically
appropriate.
Sec.
77.
Section
514C.25,
subsection
2,
paragraph
a,
subparagraph
(5),
Code
2017,
is
amended
by
striking
the
subparagraph.
Sec.
78.
Section
514C.26,
subsection
5,
paragraph
a,
subparagraph
(6),
Code
2017,
is
amended
by
striking
the
subparagraph.
Sec.
79.
Section
514C.27,
subsection
1,
unnumbered
paragraph
1,
Code
2017,
is
amended
to
read
as
follows:
Notwithstanding
the
uniformity
of
treatment
requirements
of
section
514C.6
,
a
group
policy
or
contract
providing
for
third-party
payment
or
prepayment
of
health
or
medical
expenses
issued
by
a
carrier,
as
defined
in
section
513B.2
,
or
by
an
organized
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158
,
shall
provide
coverage
benefits
to
an
insured
who
is
a
veteran
for
treatment
of
mental
illness
and
substance
abuse
if
either
of
the
following
is
satisfied:
Sec.
80.
Section
514C.27,
subsection
6,
Code
2017,
is
amended
to
read
as
follows:
6.
A
carrier
,
organized
delivery
system,
or
plan
established
pursuant
to
chapter
509A
may
manage
the
benefits
provided
through
common
methods
including
but
not
limited
to
providing
payment
of
benefits
or
providing
care
and
treatment
under
a
capitated
payment
system,
prospective
reimbursement
rate
system,
utilization
control
system,
incentive
system
for
the
use
of
least
restrictive
and
least
costly
levels
of
care,
a
preferred
provider
contract
limiting
choice
of
specific
providers,
or
any
other
system,
method,
or
organization
House
File
393,
p.
42
designed
to
assure
services
are
medically
necessary
and
clinically
appropriate.
Sec.
81.
Section
514C.29,
subsection
2,
paragraph
e,
Code
2017,
is
amended
by
striking
the
paragraph.
Sec.
82.
Section
514C.30,
subsection
2,
paragraph
e,
Code
2017,
is
amended
by
striking
the
paragraph.
Sec.
83.
Section
514E.1,
subsection
6,
paragraph
k,
Code
2017,
is
amended
by
striking
the
paragraph.
Sec.
84.
Section
514E.1,
subsection
17,
Code
2017,
is
amended
by
striking
the
subsection.
Sec.
85.
Section
514E.2,
subsection
1,
paragraph
a,
Code
2017,
is
amended
to
read
as
follows:
a.
All
carriers
and
all
organized
delivery
systems
licensed
by
the
director
of
public
health
providing
health
insurance
or
health
care
services
in
Iowa,
whether
on
an
individual
or
group
basis,
and
all
other
insurers
designated
by
the
association’s
board
of
directors
and
approved
by
the
commissioner
shall
be
members
of
the
association.
Sec.
86.
Section
514E.2,
subsection
2,
paragraph
a,
subparagraph
(3),
Code
2017,
is
amended
to
read
as
follows:
(3)
Two
members
selected
by
the
members
of
the
association,
one
of
whom
shall
be
a
representative
from
a
corporation
operating
pursuant
to
chapter
514
on
July
1,
1989,
or
any
successor
in
interest,
and
one
of
whom
shall
be
a
representative
of
an
organized
delivery
system
or
an
insurer
providing
coverage
pursuant
to
chapter
509
or
514A
.
Sec.
87.
Section
514E.7,
subsection
1,
paragraph
a,
subparagraphs
(1)
and
(2),
Code
2017,
are
amended
to
read
as
follows:
(1)
A
notice
of
rejection
or
refusal
to
issue
substantially
similar
insurance
for
health
reasons
by
one
carrier
or
organized
delivery
system
.
(2)
A
refusal
by
a
carrier
or
organized
delivery
system
to
issue
insurance
except
at
a
rate
exceeding
the
plan
rate.
Sec.
88.
Section
514E.7,
subsection
1,
paragraph
b,
Code
2017,
is
amended
to
read
as
follows:
b.
A
rejection
or
refusal
by
a
carrier
or
organized
delivery
system
offering
only
stoploss,
excess
of
loss,
or
reinsurance
coverage
with
respect
to
an
applicant
under
paragraph
“a”
,
House
File
393,
p.
43
subparagraphs
(1)
and
(2)
,
is
not
sufficient
evidence
for
purposes
of
this
subsection
.
Sec.
89.
Section
514E.9,
Code
2017,
is
amended
to
read
as
follows:
514E.9
Rules.
Pursuant
to
chapter
17A
,
the
commissioner
and
the
director
of
public
health
shall
adopt
rules
to
provide
for
disclosure
by
carriers
and
organized
delivery
systems
of
the
availability
of
insurance
coverage
from
the
association,
and
to
otherwise
implement
this
chapter
.
Sec.
90.
Section
514E.11,
Code
2017,
is
amended
to
read
as
follows:
514E.11
Notice
of
association
policy.
Every
carrier,
including
a
health
maintenance
organization
subject
to
chapter
514B
and
an
organized
delivery
system
,
authorized
to
provide
health
care
insurance
or
coverage
for
health
care
services
in
Iowa,
shall
provide
a
notice
of
the
availability
of
coverage
by
the
association
to
any
person
who
receives
a
rejection
of
coverage
for
health
insurance
or
health
care
services,
or
a
rate
for
health
insurance
or
coverage
for
health
care
services
that
will
exceed
the
rate
of
an
association
policy,
and
that
person
is
eligible
to
apply
for
health
insurance
provided
by
the
association.
Application
for
the
health
insurance
shall
be
on
forms
prescribed
by
the
association’s
board
of
directors
and
made
available
to
the
carriers
and
organized
delivery
systems
and
other
entities
providing
health
care
insurance
or
coverage
for
health
care
services
regulated
by
the
commissioner.
Sec.
91.
Section
514F.5,
Code
2017,
is
amended
to
read
as
follows:
514F.5
Experimental
treatment
review.
1.
A
carrier,
as
defined
in
section
513B.2
,
an
organized
delivery
system
authorized
under
1993
Iowa
Acts,
ch.
158,
or
a
plan
established
pursuant
to
chapter
509A
for
public
employees,
that
limits
coverage
for
experimental
medical
treatment,
drugs,
or
devices,
shall
develop
and
implement
a
procedure
to
evaluate
experimental
medical
treatments
and
shall
submit
a
description
of
the
procedure
to
the
division
of
insurance.
The
procedure
shall
be
in
writing
and
must
describe
the
process
used
to
House
File
393,
p.
44
determine
whether
the
carrier
,
organized
delivery
system,
or
chapter
509A
plan
will
provide
coverage
for
new
medical
technologies
and
new
uses
of
existing
technologies.
The
procedure,
at
a
minimum,
shall
require
a
review
of
information
from
appropriate
government
regulatory
agencies
and
published
scientific
literature
concerning
new
medical
technologies,
new
uses
of
existing
technologies,
and
the
use
of
external
experts
in
making
decisions.
A
carrier
,
organized
delivery
system,
or
chapter
509A
plan
shall
include
appropriately
licensed
or
qualified
professionals
in
the
evaluation
process.
The
procedure
shall
provide
a
process
for
a
person
covered
under
a
plan
or
contract
to
request
a
review
of
a
denial
of
coverage
because
the
proposed
treatment
is
experimental.
A
review
of
a
particular
treatment
need
not
be
reviewed
more
than
once
a
year.
2.
A
carrier
,
organized
delivery
system,
or
chapter
509A
plan
that
limits
coverage
for
experimental
treatment,
drugs,
or
devices
shall
clearly
disclose
such
limitations
in
a
contract,
policy,
or
certificate
of
coverage.
Sec.
92.
Section
514I.2,
subsection
10,
Code
2017,
is
amended
to
read
as
follows:
10.
“Participating
insurer”
means
any
entity
licensed
by
the
division
of
insurance
of
the
department
of
commerce
to
provide
health
insurance
in
Iowa
or
an
organized
delivery
system
licensed
by
the
director
of
public
health
that
has
contracted
with
the
department
to
provide
health
insurance
coverage
to
eligible
children
under
this
chapter
.
Sec.
93.
Section
514J.102,
subsection
24,
Code
2017,
is
amended
to
read
as
follows:
24.
“Health
carrier”
means
an
entity
subject
to
the
insurance
laws
and
regulations
of
this
state,
or
subject
to
the
jurisdiction
of
the
commissioner,
including
an
insurance
company
offering
sickness
and
accident
plans,
a
health
maintenance
organization,
a
nonprofit
health
service
corporation,
a
plan
established
pursuant
to
chapter
509A
for
public
employees,
or
any
other
entity
providing
a
plan
of
health
insurance,
health
care
benefits,
or
health
care
services.
“Health
carrier”
includes,
for
purposes
of
this
chapter
,
an
organized
delivery
system.
House
File
393,
p.
45
Sec.
94.
Section
514J.102,
subsection
29,
Code
2017,
is
amended
by
striking
the
subsection.
Sec.
95.
Section
514K.1,
subsection
1,
unnumbered
paragraph
1,
Code
2017,
is
amended
to
read
as
follows:
A
health
maintenance
organization
,
an
organized
delivery
system,
or
an
insurer
using
a
preferred
provider
arrangement
shall
provide
to
each
of
its
enrollees
at
the
time
of
enrollment,
and
shall
make
available
to
each
prospective
enrollee
upon
request,
written
information
as
required
by
rules
adopted
by
the
commissioner
and
the
director
of
public
health
.
The
information
required
by
rule
shall
include,
but
not
be
limited
to,
all
of
the
following:
Sec.
96.
Section
514K.1,
subsection
2,
Code
2017,
is
amended
to
read
as
follows:
2.
The
commissioner
and
the
director
shall
annually
publish
a
consumer
guide
providing
a
comparison
by
plan
on
performance
measures,
network
composition,
and
other
key
information
to
enable
consumers
to
better
understand
plan
differences.
Sec.
97.
Section
514L.1,
subsection
3,
Code
2017,
is
amended
to
read
as
follows:
3.
“Provider
of
third-party
payment
or
prepayment
of
prescription
drug
expenses”
or
“provider”
means
a
provider
of
an
individual
or
group
policy
of
accident
or
health
insurance
or
an
individual
or
group
hospital
or
health
care
service
contract
issued
pursuant
to
chapter
509
,
514
,
or
514A
,
a
provider
of
a
plan
established
pursuant
to
chapter
509A
for
public
employees,
a
provider
of
an
individual
or
group
health
maintenance
organization
contract
issued
and
regulated
under
chapter
514B
,
a
provider
of
an
organized
delivery
system
contract
regulated
under
rules
adopted
by
the
director
of
public
health,
a
provider
of
a
preferred
provider
contract
issued
pursuant
to
chapter
514F
,
a
provider
of
a
self-insured
multiple
employer
welfare
arrangement,
and
any
other
entity
providing
health
insurance
or
health
benefits
which
provide
for
payment
or
prepayment
of
prescription
drug
expenses
coverage
subject
to
state
insurance
regulation.
Sec.
98.
Section
514L.2,
subsection
1,
paragraph
a,
unnumbered
paragraph
1,
Code
2017,
is
amended
to
read
as
follows:
House
File
393,
p.
46
A
provider
of
third-party
payment
or
prepayment
of
prescription
drug
expenses,
including
the
provider’s
agents
or
contractors
and
pharmacy
benefits
managers,
that
issues
a
card
or
other
technology
for
claims
processing
and
an
administrator
of
the
payor,
excluding
administrators
of
self-funded
employer
sponsored
health
benefit
plans
qualified
under
the
federal
Employee
Retirement
Income
Security
Act
of
1974,
shall
issue
to
its
insureds
a
card
or
other
technology
containing
uniform
prescription
drug
information.
The
commissioner
of
insurance
shall
adopt
rules
for
the
uniform
prescription
drug
information
card
or
technology
applicable
to
those
entities
subject
to
regulation
by
the
commissioner
of
insurance.
The
director
of
public
health
shall
adopt
rules
for
the
uniform
prescription
drug
information
card
or
technology
applicable
to
organized
delivery
systems.
The
rules
shall
require
at
least
both
of
the
following
regarding
the
card
or
technology:
Sec.
99.
Section
521F.2,
subsection
7,
Code
2017,
is
amended
to
read
as
follows:
7.
“Health
organization”
means
a
health
maintenance
organization,
limited
service
organization,
dental
or
vision
plan,
hospital,
medical
and
dental
indemnity
or
service
corporation
or
other
managed
care
organization
licensed
under
chapter
514
,
or
514B
,
or
1993
Iowa
Acts,
ch.
158
,
or
any
other
entity
engaged
in
the
business
of
insurance,
risk
transfer,
or
risk
retention,
that
is
subject
to
the
jurisdiction
of
the
commissioner
of
insurance
or
the
director
of
public
health
.
“Health
organization”
does
not
include
an
insurance
company
licensed
to
transact
the
business
of
insurance
under
chapter
508
,
515
,
or
520
,
and
which
is
otherwise
subject
to
chapter
521E
.
Sec.
100.
1993
Iowa
Acts,
chapter
158,
section
4,
is
amended
to
read
as
follows:
SEC.
4.
EMERGENCY
RULES.
Pursuant
to
sections
1
,
and
2
,
and
3
of
this
Act,
the
commissioner
of
insurance
or
the
director
of
public
health
shall
adopt
administrative
rules
under
section
17A.4,
subsection
2,
and
section
17A.5,
subsection
2,
paragraph
“b”,
to
implement
the
provisions
of
this
Act
and
the
rules
shall
become
effective
immediately
upon
filing,
unless
a
later
effective
date
is
specified
in
the
rules.
Any
rules
adopted
in
House
File
393,
p.
47
accordance
with
the
provisions
of
this
section
shall
also
be
published
as
notice
of
intended
action
as
provided
in
section
17A.4.
Sec.
101.
REPEAL.
Section
135.120,
Code
2017,
is
repealed.
Sec.
102.
REPEAL.
1993
Iowa
Acts,
chapter
158,
section
3,
is
repealed.
Sec.
103.
CODE
EDITOR’S
DIRECTIVE.
The
Code
editor
shall
correct
and
eliminate
any
references
to
the
term
“organized
delivery
system”
or
other
forms
of
the
term
anywhere
else
in
the
Iowa
Code
or
Iowa
Code
Supplement,
in
any
bills
awaiting
codification,
in
this
Act,
and
in
any
bills
enacted
by
the
Eighty-seventh
General
Assembly,
2017
Regular
Session,
or
any
extraordinary
session.
DIVISION
VIII
HEALTH
DATA
Sec.
104.
Section
135.166,
Code
2017,
is
amended
to
read
as
follows:
135.166
Health
care
data
——
collection
and
use
——
collection
from
hospitals.
1.
a.
The
department
of
public
health
shall
enter
into
a
memorandum
of
understanding
to
utilize
the
Iowa
hospital
association
to
act
as
the
department’s
intermediary
in
collecting,
maintaining,
and
disseminating
hospital
inpatient,
outpatient,
and
ambulatory
information
data
,
as
initially
authorized
in
1996
Iowa
Acts,
ch.
1212,
§5,
subsection
1,
paragraph
“a”
,
subparagraph
(4),
and
641
IAC
177.3.
2.
b.
The
memorandum
of
understanding
shall
include
but
is
not
limited
to
provisions
that
address
the
duties
of
the
department
and
the
Iowa
hospital
association
regarding
the
collection,
reporting,
disclosure,
storage,
and
confidentiality
of
the
data.
2.
Unless
otherwise
authorized
or
required
by
state
or
federal
law,
data
collected
under
this
section
shall
not
include
the
social
security
number
of
the
individual
subject
of
the
data.
DIVISION
IX
BIRTH
CERTIFICATES
Sec.
105.
Section
144.13A,
subsections
1
and
2,
Code
2017,
are
amended
to
read
as
follows:
House
File
393,
p.
48
1.
The
state
registrar
shall
charge
the
parent
a
fee
of
twenty
dollars
for
the
registration
of
a
certificate
of
birth
as
follows:
.
a.
Beginning
July
1,
2003,
and
ending
June
30,
2005,
a
fee
of
fifteen
dollars.
b.
Beginning
July
1,
2005,
a
fee
of
twenty
dollars.
2.
The
state
registrar
shall
charge
the
parent
a
separate
fee
established
under
section
144.46
for
a
certified
copy
of
the
certificate.
The
certified
copy
shall
include
all
of
the
information
included
in
the
original
certificate
of
birth
and
shall
be
letter-sized.
The
certified
copy
shall
be
mailed
to
the
parent
by
the
state
registrar.
The
mailing
of
a
certified
copy
of
the
certificate
to
a
biological
parent
shall
not
be
precluded
by
the
execution
of
a
release
of
custody
under
chapter
600A
,
and,
upon
request,
a
biological
parent
shall
be
provided
with
a
certified
copy
of
the
certificate
unless
the
parental
rights
of
the
biological
parent
are
terminated.
Sec.
106.
Section
144.13A,
Code
2017,
is
amended
by
adding
the
following
new
subsection:
NEW
SUBSECTION
.
2A.
a.
If,
during
the
period
between
May
1993
and
October
2009,
a
parent
was
issued
a
smaller
than
letter-sized
certified
copy
of
the
certificate
of
birth
under
this
section,
which
did
not
include
all
of
the
information
included
in
the
original
certificate
of
birth,
upon
request
of
a
parent,
the
state
registrar
shall
issue
to
the
parent
a
single
letter-sized
certified
copy
replacement
that
includes
all
of
the
information
provided
in
the
original
certificate
of
birth.
A
parent
shall
not
be
required
to
exchange
the
smaller
certified
copy
for
the
larger
certified
copy
replacement,
but
may
retain
the
smaller
certified
copy.
b.
Notwithstanding
the
amount
of
the
fee
charged
under
subsection
2,
the
state
registrar
shall
not
charge
a
fee
for
the
issuance
of
a
single
letter-sized
certified
copy
of
the
certificate
of
birth
requested
by
a
parent
under
this
subsection.
c.
This
subsection
shall
not
apply
if
a
new
certificate
of
birth
was
substituted
for
the
original
certificate
of
birth
pursuant
to
section
144.24.
d.
The
department
shall
post
the
application
form
and
House
File
393,
p.
49
instructions
for
requesting
a
letter-sized
certified
copy
replacement
as
specified
in
this
subsection
on
the
department’s
internet
site.
This
paragraph
is
repealed
June
30,
2022.
______________________________
LINDA
UPMEYER
Speaker
of
the
House
______________________________
JACK
WHITVER
President
of
the
Senate
I
hereby
certify
that
this
bill
originated
in
the
House
and
is
known
as
House
File
393,
Eighty-seventh
General
Assembly.
______________________________
CARMINE
BOAL
Chief
Clerk
of
the
House
Approved
_______________,
2017
______________________________
TERRY
E.
BRANSTAD
Governor